Healthcare Provider Details

I. General information

NPI: 1629983564
Provider Name (Legal Business Name): ALBERT JOSEPH FORNACE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 RESERVOIR RD NW RM E504
WASHINGTON DC
20007-2126
US

IV. Provider business mailing address

3970 RESERVOIR RD NW RM E504
WASHINGTON DC
20007-2126
US

V. Phone/Fax

Practice location:
  • Phone: 202-687-7843
  • Fax:
Mailing address:
  • Phone: 202-687-7843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberINACTIVE
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: