Provider Demographics
NPI:1487644696
Name:FORRESTAL, THOMAS P JR
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:FORRESTAL
Suffix:JR
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:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-1821
Mailing Address - Country:US
Mailing Address - Phone:740-455-3342
Mailing Address - Fax:740-455-3686
Practice Address - Street 1:930 BETHESDA DR
Practice Address - Street 2:BUILDING 4
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-0815
Practice Address - Country:US
Practice Address - Phone:740-454-6828
Practice Address - Fax:740-454-3001
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049982-F207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0541597Medicaid
OH836068OtherBWC PROVIDER NUMBER
OH0541597Medicaid
0541534Medicare PIN