Provider Demographics
NPI:1528016748
Name:FORSYTHE, JAMES M (CRNA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:FORSYTHE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:M
Other - Last Name:FORSYTHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:690 CANTON STREET
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2329
Mailing Address - Country:US
Mailing Address - Phone:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:690 CANTON STREET
Practice Address - Street 2:SUITE 325
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2329
Practice Address - Country:US
Practice Address - Phone:781-407-7713
Practice Address - Fax:781-407-0998
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21011122300000X
RIRNA36586367500000X
MA161183367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007057702Medicare ID - Type UnspecifiedPROVIDER NUMBER
MANA043601Medicare PIN