MEDICARE: DR. ERIC JOHN FORMEISTER M.D., M.S.

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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	DR.0076773	CO
2	207Y00000X	Otolaryngology Physician	DR.0076773	CO
3	207Y00000X	Otolaryngology Physician	D89352	MD
4	207YX0901X	Otology & Neurotology Physician	DR.76773	CO

General Provider Information

NPI Number	:	1760877542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC JOHN FORMEISTER M.D., M.S.

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	2233 POST ST
Second Line	:	ROOM 03-30
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3470
Country	:	US
Telephone Number	:	415-476-4952
Fax Number	:	415-885-7546

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	06/15/2026

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