Provider Demographics
NPI:1669677415
Name:FORRESTER, PETER SCOTT (PA-C)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:SCOTT
Last Name:FORRESTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50520
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-0520
Mailing Address - Country:US
Mailing Address - Phone:843-552-4240
Mailing Address - Fax:843-552-4121
Practice Address - Street 1:1101 BOWMAN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3213
Practice Address - Country:US
Practice Address - Phone:843-552-4240
Practice Address - Fax:843-552-4121
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1648363AM0700X
GA000410207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine