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General NPI Number Information
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NPI Number | 1528082138
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Entity Type | Organization
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Legal Business Name | DARLENE L FORTH MD PC
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 231 N BROAD ST FIRST FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1511
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Country | US
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Telephone | 215-762-8443
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Fax | 215-762-7710
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Provider Business Mailing Address
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Address Line | PO BOX 73
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City | BERLIN
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State | NJ
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Zip | 08009-0073
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Country | US
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Telephone | 215-762-8443
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Fax | 215-762-7710
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARLENE LOUISE FORTH
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Credential | MD
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Telephone | 215-605-6130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD069195L
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License Number State | PA
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