Provider Demographics
NPI:1205812849
Name:LORICO, ABEGAEL N (MD)
Entity Type:Individual
Prefix:
First Name:ABEGAEL
Middle Name:N
Last Name:LORICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:741 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4309
Mailing Address - Country:US
Mailing Address - Phone:973-483-1300
Mailing Address - Fax:973-676-1396
Practice Address - Street 1:7602 CENTRAL AVE
Practice Address - Street 2:STE 201
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111-2443
Practice Address - Country:US
Practice Address - Phone:215-745-8989
Practice Address - Fax:215-745-9072
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10339000207V00000X
PAMD034135L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30038160OtherKEYSTONE MERCY HEALTH
PA3209082OtherAETNA HMO
PAP00025015OtherRR MEDICARE
PA000923757Medicaid
PA4101135OtherAETNA PPO
PA110157OtherHIGHMARK BLUE SHIELD
PA4564OtherBRAVO HEALTH
PA0052859000OtherINDEPENDENCE BLUE CROSS
PA2117910OtherMAMSI LIFE & HEALTH
PA2117910OtherMAMSI LIFE & HEALTH
PA000923757Medicaid