Healthcare Provider Details

I. General information

NPI: 1962482257
Provider Name (Legal Business Name): FORNANCE PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W GERMANTOWN PIKE
EAST NORRITON PA
19403-4250
US

IV. Provider business mailing address

PO BOX 789967
PHILADELPHIA PA
19178-9967
US

V. Phone/Fax

Practice location:
  • Phone: 484-622-1435
  • Fax:
Mailing address:
  • Phone: 484-622-7395
  • Fax: 484-622-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VERA BURNETT-ROBINS
Title or Position: BILLING DIRECTOR
Credential:
Phone: 484-622-7391