Healthcare Provider Details

I. General information

NPI: 1972500239
Provider Name (Legal Business Name): ALICIA M FORSTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 FAIRVIEW AVE STE 334
SKOWHEGAN ME
04976-1481
US

IV. Provider business mailing address

PO BOX 468
SKOWHEGAN ME
04976-0468
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-6201
  • Fax: 207-474-0969
Mailing address:
  • Phone: 207-474-6201
  • Fax: 207-474-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15760
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: