Provider Demographics
NPI:1649239716
Name:FORESTER, BRENT PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:PETER
Last Name:FORESTER
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 1:357 WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1361
Mailing Address - Country:US
Mailing Address - Phone:617-855-3622
Mailing Address - Fax:617-855-3246
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1041
Practice Address - Country:US
Practice Address - Phone:617-855-3622
Practice Address - Fax:617-855-3246
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA789032084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFOJ16261OtherBCBS
MAY02835Medicare PIN
MAF93460Medicare UPIN