Provider Demographics
NPI:1376580902
Name:FORMICA, ARMAND (DO)
Entity Type:Individual
Prefix:DR
First Name:ARMAND
Middle Name:
Last Name:FORMICA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:532 OLD MARLTON PIKE W
Mailing Address - Street 2:W-138
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2075
Mailing Address - Country:US
Mailing Address - Phone:215-831-1017
Mailing Address - Fax:856-424-6065
Practice Address - Street 1:8400 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2081
Practice Address - Country:US
Practice Address - Phone:215-831-1017
Practice Address - Fax:856-424-6065
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS002928L207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005927990001Medicaid
PA1429618OtherBLUE SHIELD
PA2118411001OtherKEYSTONE
PA0005927990001Medicaid