Healthcare Provider Details

I. General information

NPI: 1265445365
Provider Name (Legal Business Name): STEVEN D FORMAN M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ALLEGHENY CTR FL 8
PITTSBURGH PA
15212-5255
US

IV. Provider business mailing address

4 ALLEGHENY CTR FL 8
PITTSBURGH PA
15212-5255
US

V. Phone/Fax

Practice location:
  • Phone: 412-330-4000
  • Fax:
Mailing address:
  • Phone: 412-330-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD042812L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD042812L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD042812L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: