MEDICARE: ABEGAEL N LORICO 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	207V00000X	Obstetrics & Gynecology Physician	25MA10339000	NJ
2	207V00000X	Obstetrics & Gynecology Physician	MD034135L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00025015	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30038160	OTHER	PA	KEYSTONE MERCY HEALTH
2	3209082	OTHER	PA	AETNA HMO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4101135	OTHER	PA	AETNA PPO
6	110157	OTHER	PA	HIGHMARK BLUE SHIELD
7	4564	OTHER	PA	BRAVO HEALTH
8	0052859000	OTHER	PA	INDEPENDENCE BLUE CROSS
9	2117910	OTHER	PA	MAMSI LIFE & HEALTH

General Provider Information

NPI Number	:	1205812849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABEGAEL N LORICO MD

Provider Business Mailing Address
First Line	:	741 BROADWAY
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-4309
Country	:	US
Telephone Number	:	973-483-1300
Fax Number	:	973-676-1396

Provider Business Practice Location Address
First Line	:	7602 CENTRAL AVE
Second Line	:	STE 201
City	:	PHILA
State	:	PA
Zip	:	19111-2443
Country	:	US
Telephone Number	:	215-745-8989
Fax Number	:	215-745-9072

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	10/20/2022

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Directions to “ ABEGAEL N LORICO MD” Practice Location

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