Provider Demographics
NPI:1598722886
Name:JAMES S FORRESTER MD PA
Entity Type:Organization
Organization Name:JAMES S FORRESTER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:704-263-4716
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28164-0459
Mailing Address - Country:US
Mailing Address - Phone:704-263-4716
Mailing Address - Fax:704-263-8169
Practice Address - Street 1:510 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NC
Practice Address - Zip Code:28164-2056
Practice Address - Country:US
Practice Address - Phone:704-263-4716
Practice Address - Fax:704-263-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13442207Q00000X
NC28091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901947Medicaid
NC1336126770OtherNPI
NC1407833957OtherNPI
NC1336126770OtherNPI
NCC79967Medicare UPIN
NCC89509Medicare UPIN