Provider Demographics
NPI:1013322064
Name:GARY FORRISTER M.D. P.C.
Entity type:Organization
Organization Name:GARY FORRISTER M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:FORRISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-240-7964
Mailing Address - Street 1:923 ROUTE 6A STE W
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2159
Mailing Address - Country:US
Mailing Address - Phone:774-994-8376
Mailing Address - Fax:774-994-8642
Practice Address - Street 1:923 ROUTE 6A STE W
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2159
Practice Address - Country:US
Practice Address - Phone:774-994-8376
Practice Address - Fax:774-994-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-29
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA780062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF98381Medicare UPIN
MAA32496Medicare PIN