Provider Demographics
NPI:1467402685
Name:FORRISTER, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:FORRISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 ROUTE 6A
Mailing Address - Street 2:UNIT W
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2159
Mailing Address - Country:US
Mailing Address - Phone:774-994-8376
Mailing Address - Fax:774-994-8642
Practice Address - Street 1:923 ROUTE 6A
Practice Address - Street 2:UNIT W
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2159
Practice Address - Country:US
Practice Address - Phone:774-994-8376
Practice Address - Fax:774-994-8642
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA780062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A32496Medicare ID - Type Unspecified
F98381Medicare UPIN