Provider Demographics
NPI:1073583332
Name:FORSTER, CARL J (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:J
Last Name:FORSTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 S CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3003
Mailing Address - Country:US
Mailing Address - Phone:570-628-0800
Mailing Address - Fax:570-622-7811
Practice Address - Street 1:13 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3003
Practice Address - Country:US
Practice Address - Phone:570-628-0800
Practice Address - Fax:570-622-7811
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003442L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000590220Medicaid
PA000590220Medicaid
PA170507JPUMedicare PIN