Healthcare Provider Details

I. General information

NPI: 1326146812
Provider Name (Legal Business Name): ALLAN FORTE PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WASH VHA - MC / DEPT OF NEUROLOGY 50 IRVING ST N.W.
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

3212 DORCHESTER RD
BALTIMORE MD
21215-7460
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax: 202-745-8231
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC01415
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: