Provider Demographics
NPI:1144398942
Name:FORMAN, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FORMAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:269 LOCUST STREET
Mailing Address - Street 2:BALIN EYE AND LASER CENTER
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062
Mailing Address - Country:US
Mailing Address - Phone:413-584-6666
Mailing Address - Fax:413-584-7428
Practice Address - Street 1:269 LOCUST STREET
Practice Address - Street 2:BALIN EYE AND LASER CENTER
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-3222
Practice Address - Country:US
Practice Address - Phone:413-584-6666
Practice Address - Fax:914-277-5735
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2021-0882207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01005930Medicaid
NY58D601Medicare PIN
NY01005930Medicaid