Healthcare Provider Details

I. General information

NPI: 1790725497
Provider Name (Legal Business Name): LEIGH J FORBUSH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 MAIN RD N
HAMPDEN ME
04444-1804
US

IV. Provider business mailing address

603 MAIN RD N STE 1
HAMPDEN ME
04444-1804
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-5400
  • Fax: 866-463-6751
Mailing address:
  • Phone: 207-945-5400
  • Fax: 866-463-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1760
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: