Provider Demographics
NPI:1114968401
Name:FORSYTH, RICHARD JAMES (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 EXECUTIVE DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7445
Mailing Address - Country:US
Mailing Address - Phone:919-878-8596
Mailing Address - Fax:919-878-0744
Practice Address - Street 1:3320 EXECUTIVE DR
Practice Address - Street 2:SUITE 214
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7445
Practice Address - Country:US
Practice Address - Phone:919-878-8596
Practice Address - Fax:919-878-0744
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC206360Medicare ID - Type Unspecified
NCC87967Medicare UPIN