Provider Demographics
NPI:1720165046
Name:FORSYTH, GREG SCOT (PA-C)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:SCOT
Last Name:FORSYTH
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 1:940 CENTURY DR STE A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4376
Mailing Address - Country:US
Mailing Address - Phone:717-458-5407
Mailing Address - Fax:717-620-8298
Practice Address - Street 1:940 CENTURY DR STE A
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055
Practice Address - Country:US
Practice Address - Phone:717-458-5407
Practice Address - Fax:717-620-8298
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103146781Medicaid
PA103146781Medicaid
PA115122Medicare PIN