Provider Demographics
NPI:1689873812
Name:JANE L. FORREST MD, PA
Entity Type:Organization
Organization Name:JANE L. FORREST MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-332-2101
Mailing Address - Street 1:165 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3465
Mailing Address - Country:US
Mailing Address - Phone:603-332-2101
Mailing Address - Fax:
Practice Address - Street 1:165 CHARLES ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3465
Practice Address - Country:US
Practice Address - Phone:603-332-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5933174400000X, 207K00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE0605Medicare PIN