Provider Demographics
NPI:1952850315
Name:THOMAS P FORRESTAL JR
Entity Type:Organization
Organization Name:THOMAS P FORRESTAL JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:FORRESTAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:740-607-7229
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:DUNCAN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:43734-0462
Mailing Address - Country:US
Mailing Address - Phone:740-319-1335
Mailing Address - Fax:740-297-4963
Practice Address - Street 1:1115 STONINGTON PL
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7210
Practice Address - Country:US
Practice Address - Phone:740-607-7229
Practice Address - Fax:740-297-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH049982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty