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NPI Code Detail

MEDICARE: DR. CHRISTOPHER FORMAL MD

MEDICARE: DR. CHRISTOPHER FORMAL 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
1208100000XPhysical Medicine & Rehabilitation PhysicianMD024740EPA

General Provider Information

NPI Number : 1801874656
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER FORMAL MD
Provider Business Mailing Address
First Line : 1513 RACE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-1125
Country : US
Telephone Number : 215-587-3159
Fax Number : 215-587-9405
Provider Business Practice Location Address
First Line : 1513 RACE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19102-1125
Country : US
Telephone Number : 215-587-3159
Fax Number : 215-587-9405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 04/16/2008

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Directions to “ DR. CHRISTOPHER FORMAL MD” Practice Location

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