Provider Demographics
NPI:1336119742
Name:MASTOOR, MOMINA I (MD)
Entity Type:Individual
Prefix:DR
First Name:MOMINA
Middle Name:I
Last Name:MASTOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-399-3105
Mailing Address - Fax:717-798-3670
Practice Address - Street 1:450 S WASHINGTON ST STE A
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2500
Practice Address - Country:US
Practice Address - Phone:717-339-3105
Practice Address - Fax:717-798-3670
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050822207RC0000X
PAMD468797207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH41117Medicare UPIN