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General NPI Number Information
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NPI Number | 1437438645
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Entity Type | Individual
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Provider Name | IVIS THEODORE FORRESTER PH.D., RD
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Gender | Female
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 3939 REISTERSTOWN RD
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City | BALTIMORE
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State | MD
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Zip | 21251
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Country | US
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Telephone | 410-367-7821
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Fax | 410-367-7823
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Provider Business Mailing Address
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Address Line | 6210 GLEN FALLS RD
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City | REISTERSTOWN
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State | MD
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Zip | 21136
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Country | US
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Telephone | 410-833-3682
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Fax | 410-833-3682
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D02016
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number | D02016
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License Number State | MD
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