Provider Demographics
NPI:1578071445
Name:FORSELL, KEVIN GREGORY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GREGORY
Last Name:FORSELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MCFARLAN RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2453
Mailing Address - Country:US
Mailing Address - Phone:610-444-5678
Mailing Address - Fax:
Practice Address - Street 1:402 MCFARLAN RD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2453
Practice Address - Country:US
Practice Address - Phone:610-444-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-13
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine