Provider Demographics
NPI:1629183033
Name:FORSYTH, KYLE L (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:L
Last Name:FORSYTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1544
Mailing Address - Country:US
Mailing Address - Phone:610-687-0715
Mailing Address - Fax:610-964-1228
Practice Address - Street 1:139 BERKELEY RD
Practice Address - Street 2:
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1544
Practice Address - Country:US
Practice Address - Phone:610-687-0715
Practice Address - Fax:610-964-1228
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033804E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10926873OtherCAQH
BF0175629OtherDEA
BF0175629OtherDEA
PA486240Medicare PIN
10926873OtherCAQH