Provider Demographics
NPI:1497967897
Name:FORESTER, DAVID LIONEL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LIONEL
Last Name:FORESTER
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 1:1000 TULIP ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-2118
Mailing Address - Country:US
Mailing Address - Phone:423-232-2995
Mailing Address - Fax:
Practice Address - Street 1:209 E UNAKA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4625
Practice Address - Country:US
Practice Address - Phone:423-434-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN345312084P0800X
VA01010452292084P0800X
CAG617012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3863365Medicare ID - Type UnspecifiedPSYCHIATRY
TNE47692Medicare UPIN