Provider Demographics
NPI:1598725749
Name:WRIGHT, MICHAEL FORREST (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FORREST
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 PLAZA DR
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2448
Practice Address - Country:US
Practice Address - Phone:570-368-3321
Practice Address - Fax:570-368-2512
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1394000OtherHIGHMARK BLUE SHIELD
PA2517533OtherUNITEDHEALTHCARE
PA7550337OtherAETNA
PA0019004610001Medicaid
PA0019004610004Medicaid
PA002917OtherFIRST PRIORITY HEALTH
PAH61293OtherHEALTHAMERICA
PA080185099Medicare PIN
PA058081Medicare PIN
H61293Medicare UPIN