MEDICARE: FORNANCE PHYSICIAN SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0203X	Therapeutic Radiology Physician
2	2085R0001X	Radiation Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0194239000	OTHER	PA	AMERIHEALTH/INTERCOUNTY
2	054706	OTHER	PA	HIGHMARK BLUE SHIELD
3	1053316	OTHER	PA	KEYSTONE MERCY
4	0194239000	OTHER	PA	IBC - PC, KHPE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	5015635	OTHER	PA	AETNA PPO
7	25096	OTHER	PA	HEALTH PARTNERS
8	2110590	OTHER	PA	AETNA HMO

General Provider Information

NPI Number	:	1417927187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORNANCE PHYSICIAN SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 820137
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-0137
Country	:	US
Telephone Number	:	610-270-2352
Fax Number	:	610-270-2358

Provider Business Practice Location Address
First Line	:	1330 POWELL ST
Second Line	:	SUITE 308
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-3353
Country	:	US
Telephone Number	:	610-270-2192
Fax Number	:	610-270-2364

Authorized Official
Title or Position	:	DIRECTOR PHYSICIAN BILLING
Name	:	VERA BURNETT-ROBINS
Credential	:
Telephone Number	:	484-622-7391

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/17/2018

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Directions to “FORNANCE PHYSICIAN SERVICES, INC. ” Practice Location

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