Healthcare Provider Details

I. General information

NPI: 1861754855
Provider Name (Legal Business Name): DEREK FORSTHOEFEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVENUE
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVENUE
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0196
  • Fax:
Mailing address:
  • Phone: 301-295-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35123882
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: