Basic Information
| Provider Information | |||||||||
| NPI: | 1205812849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LORICO | ||||||||
| FirstName: | ABEGAEL | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 741 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071044309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734831300 | ||||||||
| FaxNumber: | 9736761396 | ||||||||
| Practice Location | |||||||||
| Address1: | 7602 CENTRAL AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | PHILA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157458989 | ||||||||
| FaxNumber: | 2157459072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MA10339000 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD034135L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 30038160 | 01 | PA | KEYSTONE MERCY HEALTH | OTHER | 3209082 | 01 | PA | AETNA HMO | OTHER | P00025015 | 01 | PA | RR MEDICARE | OTHER | 000923757 | 05 | PA | MEDICAID | 4101135 | 01 | PA | AETNA PPO | OTHER | 110157 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 4564 | 01 | PA | BRAVO HEALTH | OTHER | 0052859000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 2117910 | 01 | PA | MAMSI LIFE & HEALTH | OTHER |