Provider Demographics
NPI:1275067506
Name:BASHUA, RALIAT
Entity type:Individual
Prefix:DR
First Name:RALIAT
Middle Name:
Last Name:BASHUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RALIAT
Other - Middle Name:
Other - Last Name:MOHAMMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423 N 21ST ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2207
Mailing Address - Country:US
Mailing Address - Phone:717-763-9880
Mailing Address - Fax:717-737-2765
Practice Address - Street 1:423 N 21ST ST STE 202
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2207
Practice Address - Country:US
Practice Address - Phone:717-763-9880
Practice Address - Fax:717-202-0100
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFB0785040207V00000X
NY390200000X
PAMD475568207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133971298OtherEIN