Provider Demographics
NPI: | 1750510376 |
---|---|
Name: | JOSEPH FORESTIERE MD LTD |
Entity Type: | Organization |
Organization Name: | JOSEPH FORESTIERE MD LTD |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FORESTIERE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 757-490-2855 |
Mailing Address - Street 1: | 533 NEWTOWN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | VIRGINIA BEACH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23462-5600 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-490-2855 |
Mailing Address - Fax: | 757-747-9055 |
Practice Address - Street 1: | 533 NEWTOWN RD |
Practice Address - Street 2: | |
Practice Address - City: | VIRGINIA BEACH |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23462-5600 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-490-2855 |
Practice Address - Fax: | 757-747-9055 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-07-02 |
Last Update Date: | 2009-07-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101026971 | 261QP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |