Provider Demographics
NPI:1518389550
Name:MARY J. FORBES, MD, PLLC
Entity Type:Organization
Organization Name:MARY J. FORBES, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-616-6499
Mailing Address - Street 1:4301 LAKE BOONE TRL
Mailing Address - Street 2:STE. 208
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7507
Mailing Address - Country:US
Mailing Address - Phone:919-616-6499
Mailing Address - Fax:
Practice Address - Street 1:4301 LAKE BOONE TRL
Practice Address - Street 2:STE 208
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7507
Practice Address - Country:US
Practice Address - Phone:919-616-6499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1174509400OtherINDIVIDUAL NPI
NCG14100Medicare UPIN