Provider Demographics
NPI:1609923507
Name:MUTHAURA, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MUTHAURA
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 1:344 GLENN ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1784
Mailing Address - Country:US
Mailing Address - Phone:856-220-4585
Mailing Address - Fax:
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BLDG#1, SUITE 104
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423543207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD0423543IOtherMEDICAL LICENSE
PAMD0423543IOtherMEDICAL LICENSE
PABM8683864OtherDEA
PA082099KGYMedicare ID - Type Unspecified