Provider Demographics
NPI:1881629178
Name:FODA, RANDA BAHER (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDA
Middle Name:BAHER
Last Name:FODA
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 1:2000 ACADEMY DR STE 600
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2833
Mailing Address - Country:US
Mailing Address - Phone:856-914-9656
Mailing Address - Fax:
Practice Address - Street 1:2000 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2831
Practice Address - Country:US
Practice Address - Phone:856-985-9100
Practice Address - Fax:856-985-9106
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07595300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078874Medicare ID - Type Unspecified
NJH57286Medicare UPIN