Provider Demographics
NPI:1508920455
Name:FORTH MD PC, DARLENE (MD)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:FORTH MD PC
Suffix:
Gender:F
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:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-0073
Mailing Address - Country:US
Mailing Address - Phone:215-762-8443
Mailing Address - Fax:215-762-7710
Practice Address - Street 1:231 N BROAD ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1511
Practice Address - Country:US
Practice Address - Phone:215-762-8443
Practice Address - Fax:215-762-7710
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS069195L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
044032T67Medicare ID - Type Unspecified