Provider Demographics
NPI:1912303033
Name:BAHORA, MASUMA (MD)
Entity Type:Individual
Prefix:
First Name:MASUMA
Middle Name:
Last Name:BAHORA
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 1:609 W GERMANTOWN PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4243
Mailing Address - Country:US
Mailing Address - Phone:484-622-7940
Mailing Address - Fax:
Practice Address - Street 1:210 MALL BLVD STE 220
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406
Practice Address - Country:US
Practice Address - Phone:484-622-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09582000207V00000X
PAMD457598207V00000X
PA25MA09582000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty