MEDICARE: DR. MARY J FORBES M.D.

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	207R00000X	Internal Medicine Physician	9500904	NC

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

General Provider Information

NPI Number	:	1174509400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY J FORBES M.D.

Provider Business Mailing Address
First Line	:	4301 LAKE BOONE TRL
Second Line	:	SUITE 208
City	:	RALEIGH
State	:	NC
Zip	:	27607-7507
Country	:	US
Telephone Number	:	919-977-0013
Fax Number	:	919-977-1029

Provider Business Practice Location Address
First Line	:	4301 LAKE BOONE TRL
Second Line	:	SUITE 208
City	:	RALEIGH
State	:	NC
Zip	:	27607-7507
Country	:	US
Telephone Number	:	919-977-0013
Fax Number	:	919-977-1029

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	04/23/2014

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