Healthcare Provider Details

I. General information

NPI: 1225211055
Provider Name (Legal Business Name): THOMAS MARTIN FORSBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS ROAD
LYNCHBURG VA
24501
US

IV. Provider business mailing address

1901 TATE SPRINGS RD CENTRA HEALTH EMERGENCY PHYSICIANS
LYNCHBURG VA
24501-1109
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101245048
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: