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General NPI Number Information
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NPI Number | 1144811704
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Entity Type | Organization
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Legal Business Name | FORNANCE PHYSICIAN SERVICES INC
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 210 MALL BLVD STE 202
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3260
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Country | US
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Telephone | 484-622-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 789967
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City | PHILADELPHIA
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State | PA
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Zip | 19178-9967
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PHYSICIAN BILLING
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Name | VERA BURNETT-ROBINS
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Credential |
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Telephone | 484-622-7399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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