Provider Demographics
NPI:1164427266
Name:FORBES, DAVID J (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:FORBES
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 BANNEKER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3103
Mailing Address - Country:US
Mailing Address - Phone:410-457-3196
Mailing Address - Fax:410-457-3197
Practice Address - Street 1:5840 BANNEKER RD STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3156
Practice Address - Country:US
Practice Address - Phone:410-457-3196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR113539363LF0000X, 363L00000X, 364SP0808X
MDR1-3539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407499800Medicaid
MD216SMedicare UPIN
MDQ11136Medicare UPIN