Provider Demographics
NPI:1164858858
Name:BASHORE, CAROLINE (DO)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BASHORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:PROFESSIONAL OFFICE BLDG 1, STE. 305
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-874-6448
Mailing Address - Fax:
Practice Address - Street 1:30 MEDICAL CENTER BOULEVARD
Practice Address - Street 2:PROFESSIONAL OFFICE BLDG 1, STE. 305
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-874-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018759207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology