Provider Demographics
NPI:1073577300
Name:FORREST, ELIZABETH D (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:FORREST
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4020 RAINTREE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3749
Mailing Address - Country:US
Mailing Address - Phone:757-686-5673
Mailing Address - Fax:757-489-0485
Practice Address - Street 1:4020 RAINTREE RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3749
Practice Address - Country:US
Practice Address - Phone:757-686-5673
Practice Address - Fax:757-489-0485
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101042209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5806135Medicaid
VAF35235Medicare UPIN
VA5806135Medicaid
VA110006862Medicare PIN