Provider Demographics
NPI:1326023953
Name:FORTE, KENTON E (MD)
Entity Type:Individual
Prefix:DR
First Name:KENTON
Middle Name:E
Last Name:FORTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1806
Mailing Address - Country:US
Mailing Address - Phone:716-886-4202
Mailing Address - Fax:716-884-9168
Practice Address - Street 1:964 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1806
Practice Address - Country:US
Practice Address - Phone:716-886-4202
Practice Address - Fax:716-884-9168
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1656651207RC0000X
NY165665208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01183146Medicaid
NYE67697Medicare UPIN