Provider Demographics
NPI:1972500239
Name:FORSTER, ALICIA M (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:FORSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-474-6201
Mailing Address - Fax:207-474-0969
Practice Address - Street 1:46 FAIRVIEW AVE STE 334
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1481
Practice Address - Country:US
Practice Address - Phone:207-474-6201
Practice Address - Fax:207-474-0969
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD15760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM941504OtherMEDICARE PTAN
ME1972500239Medicaid
ME1972500239Medicaid