MEDICARE: DR. ROBERT ALAN FORINASH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	200200353	NC
2	2084P0800X	Psychiatry Physician	200200353	NC
3	2084P0802X	Addiction Psychiatry Physician	200200353	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1356K	OTHER	NC	BLUE CROSS BS OF NC PIN
3	200200353	OTHER	NC	NORTH CAROLINA MEDICAL BOARD
4	562211430	OTHER	NC	TRICARE NORTH

General Provider Information

NPI Number	:	1639239254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALAN FORINASH MD

Provider Business Mailing Address
First Line	:	200 E 2ND AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4358
Country	:	US
Telephone Number	:	704-874-1904
Fax Number	:	704-867-2134

Provider Business Practice Location Address
First Line	:	111 E 3RD AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4343
Country	:	US
Telephone Number	:	704-874-3300
Fax Number	:	704-874-0065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	10/21/2019

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