Healthcare Provider Details

I. General information

NPI: 1689873812
Provider Name (Legal Business Name): JANE L. FORREST MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CHARLES ST
ROCHESTER NH
03867-3465
US

IV. Provider business mailing address

165 CHARLES ST
ROCHESTER NH
03867-3465
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-2101
  • Fax:
Mailing address:
  • Phone: 603-332-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number5933
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5933
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5933
License Number StateNH

VIII. Authorized Official

Name: DR. JANE L. FORREST
Title or Position: PRESIDENT
Credential: M.D.
Phone: 603-332-2101