Provider Demographics
NPI:1437188752
Name:FORREST, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:FORREST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:121 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4430
Mailing Address - Country:US
Mailing Address - Phone:518-439-2614
Mailing Address - Fax:
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:@ ST. PETER'S HOSPITAL ER DEPT
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:518-525-1324
Practice Address - Fax:518-383-4223
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY149736-1207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00771357Medicaid
NY00771357Medicaid