Provider Demographics
NPI:1205093119
Name:SCHUCKER, FORREST A (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:A
Last Name:SCHUCKER
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15926-9360
Mailing Address - Country:US
Mailing Address - Phone:814-754-5814
Mailing Address - Fax:
Practice Address - Street 1:433 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:PA
Practice Address - Zip Code:15926-9360
Practice Address - Country:US
Practice Address - Phone:814-754-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018620E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB35362Medicare UPIN