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1760472492

NPI Code Detail

MEDICARE: DR. JOHN B FOBIA MD

MEDICARE: DR. JOHN B FOBIA MD

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	208600000X	Surgery Physician	MD021128	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4100588	OTHER	PA	AETNA OTHER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1153304	OTHER	PA	KEYSTONE MERCY HEALTH PLA
4	1544375	OTHER	PA	BLUE SHIELD
5	0052566000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
6	2610919	OTHER	PA	AETNA HMO

General Provider Information

NPI Number	:	1760472492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN B FOBIA MD

Provider Business Mailing Address
First Line	:	1 W ELM ST
Second Line	:	2ND FLOOR
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-2007
Country	:	US
Telephone Number	:	610-567-6964
Fax Number	:	610-567-6170

Provider Business Practice Location Address
First Line	:	501 S 54TH ST
Second Line	:	SUITE 227
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1900
Country	:	US
Telephone Number	:	215-748-9653
Fax Number	:	215-748-9667

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	10/23/2008

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Directions to “ DR. JOHN B FOBIA MD” Practice Location

Language	Start Address	Practice Location

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