Provider Demographics
NPI:1144937434
Name:FORSYTH, MARK ALLAN
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLAN
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3800
Mailing Address - Country:US
Mailing Address - Phone:561-638-4733
Mailing Address - Fax:561-638-4734
Practice Address - Street 1:4665 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3800
Practice Address - Country:US
Practice Address - Phone:561-638-4733
Practice Address - Fax:561-638-4734
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2485332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment