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NPI Code Detail

MEDICARE: PATTI I FOREST MD

MEDICARE: PATTI I FOREST MD
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
1207Q00000XFamily Medicine PhysicianMD062978LPA

General Provider Information

NPI Number : 1356305817
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATTI I FOREST MD
Provider Business Mailing Address
First Line : 623 E BROAD ST
Second Line : 2ND FLR
City : BETHLEHEM
State : PA
Zip : 18018-6332
Country : US
Telephone Number : 610-954-6048
Fax Number : 610-954-3189
Provider Business Practice Location Address
First Line : 2830 EASTON AVE
Second Line :
City : BETHLEHEM
State : PA
Zip : 18017-4204
Country : US
Telephone Number : 610-954-3555
Fax Number : 610-954-3560
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 07/09/2007

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