Provider Demographics
NPI:1831240191
Name:FORRESTER, LEIGHTON HUGH (MD)
Entity type:Individual
Prefix:
First Name:LEIGHTON
Middle Name:HUGH
Last Name:FORRESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 HANOVER PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2010
Mailing Address - Country:US
Mailing Address - Phone:301-345-7878
Mailing Address - Fax:301-345-4375
Practice Address - Street 1:7500 HANOVER PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2010
Practice Address - Country:US
Practice Address - Phone:301-345-7878
Practice Address - Fax:301-345-4375
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50913207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD184691400Medicaid
MDF40384Medicare UPIN
MD184691400Medicaid