Provider Demographics
NPI:1912280181
Name:FORRESTER, RENEE KAY-DAWN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:KAY-DAWN
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:KAY-DAWN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7703 NEW SECOND ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3513
Mailing Address - Country:US
Mailing Address - Phone:215-848-4104
Mailing Address - Fax:215-782-8004
Practice Address - Street 1:7703 NEW SECOND ST
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3513
Practice Address - Country:US
Practice Address - Phone:215-848-4104
Practice Address - Fax:215-782-8004
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006280213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASC006280OtherSTATE LICENCE
PASC006280OtherSTATE LICENCE