Provider Demographics
NPI:1639148604
Name:FORCHA, ALOYSIUS B (PA-C)
Entity type:Individual
Prefix:
First Name:ALOYSIUS
Middle Name:B
Last Name:FORCHA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 ARIEL ST N APT 106
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2877
Mailing Address - Country:US
Mailing Address - Phone:216-256-3521
Mailing Address - Fax:
Practice Address - Street 1:45 W. 10TH ST
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:216-256-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008918363A00000X
TXPA07135363A00000X
MN1695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N94260013Medicare ID - Type UnspecifiedWPS