Provider Demographics
NPI:1326469396
Name:FORSANG, CLEFORD N
Entity Type:Individual
Prefix:
First Name:CLEFORD
Middle Name:N
Last Name:FORSANG
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 1:13005 MISTLETOE SPRING RD APT 713
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1607
Mailing Address - Country:US
Mailing Address - Phone:202-710-2330
Mailing Address - Fax:
Practice Address - Street 1:13005 MISTLETOE SPRING RD APT 713
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1607
Practice Address - Country:US
Practice Address - Phone:202-710-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide