Provider Demographics
NPI:1174509905
Name:FORREST, JOHN N JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:N
Last Name:FORREST
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 GEORGE ST 6TH FLOOR
Mailing Address - Street 2:PO BOX 9805
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:DANA BUILDING - 3RD FLOOR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-785-4184
Practice Address - Fax:203-785-7068
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0140092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001140094Medicaid
CT001140094Medicaid
CT110001724Medicare ID - Type Unspecified