Healthcare Provider Details

I. General information

NPI: 1013015924
Provider Name (Legal Business Name): PAUL EDWARD FORST M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 PORTER ST
FORT DETRICK MD
21702-9210
US

IV. Provider business mailing address

1231 CANON WAY
WESTMINSTER MD
21157-5762
US

V. Phone/Fax

Practice location:
  • Phone: 301-619-6917
  • Fax: 301-619-7676
Mailing address:
  • Phone: 410-857-3542
  • Fax: 410-871-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0033281
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: