Provider Demographics
NPI:1609938224
Name:FORTE, EDMUND JOHN (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:JOHN
Last Name:FORTE
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 1:101 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6952
Mailing Address - Country:US
Mailing Address - Phone:410-749-9290
Mailing Address - Fax:410-543-9087
Practice Address - Street 1:101 MILFORD ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6952
Practice Address - Country:US
Practice Address - Phone:410-749-9290
Practice Address - Fax:410-543-9087
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036073207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT6990003OtherCAREFIRST BLUE CHOICE
MD276801100Medicaid
4410369OtherAETNA
DE0000102201Medicaid
VA006356231Medicaid
20885OtherMAMSI
MD352275OtherCAREFIRST BCBS
MD276801100Medicaid
180011937Medicare ID - Type UnspecifiedRAILROAD
VA006356231Medicaid
MDH788N826Medicare ID - Type Unspecified