MEDICARE: DR. ARMAND FORMICA DO

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	OS002928L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1429618	OTHER	PA	BLUE SHIELD
3	2118411001	OTHER	PA	KEYSTONE

General Provider Information

NPI Number	:	1376580902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARMAND FORMICA DO

Provider Business Mailing Address
First Line	:	532 OLD MARLTON PIKE W
Second Line	:	W-138
City	:	MARLTON
State	:	NJ
Zip	:	08053-2075
Country	:	US
Telephone Number	:	215-831-1017
Fax Number	:	856-424-6065

Provider Business Practice Location Address
First Line	:	8400 ROOSEVELT BLVD
Second Line	:	SUITE 220
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2081
Country	:	US
Telephone Number	:	215-831-1017
Fax Number	:	856-424-6065

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/06/2013

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Directions to “ DR. ARMAND FORMICA DO” Practice Location

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