Provider Demographics
NPI:1427051515
Name:FORGACH, PETER WM (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:WM
Last Name:FORGACH
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 1:405 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5725
Mailing Address - Country:US
Mailing Address - Phone:716-633-7386
Mailing Address - Fax:716-633-7970
Practice Address - Street 1:405 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5725
Practice Address - Country:US
Practice Address - Phone:716-633-7386
Practice Address - Fax:716-633-7970
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
NY117465207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00508006001OtherBLUE CROSS PROVIDER ID
NY08-03548OtherIHA PROVIDER ID
NY117465-5OtherWORKERS' COMPENSATION ID
NY00630873Medicaid
NY00010308501OtherUNIVERA PROVIDER ID
NYY019761OtherCHAMPUS PROVIDER ID
NY00508006001OtherBLUE CROSS PROVIDER ID
NYY019761OtherCHAMPUS PROVIDER ID