Provider Demographics
NPI:1184685588
Name:FORREST, ELIZABETH G (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:G
Last Name:FORREST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:23000 MOAKLEY STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650
Mailing Address - Country:US
Mailing Address - Phone:301-475-5555
Mailing Address - Fax:301-475-8535
Practice Address - Street 1:23000 MOAKLEY STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-475-5555
Practice Address - Fax:301-475-8535
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0052414225400000X
TXJ9034208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411L589VMedicare ID - Type UnspecifiedMEDICARE ID
MDG15471Medicare UPIN