Provider Demographics
NPI:1528082138
Name:DARLENE L FORTH MD PC
Entity type:Organization
Organization Name:DARLENE L FORTH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:FORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-605-6130
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-0073
Mailing Address - Country:US
Mailing Address - Phone:215-762-8443
Mailing Address - Fax:215-762-7710
Practice Address - Street 1:231 N BROAD ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1511
Practice Address - Country:US
Practice Address - Phone:215-762-8443
Practice Address - Fax:215-762-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069195L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0182375601Medicaid
090312OtherBLUE SHIELD
32770MD069195LOtherHEALTH PARTNERS
PA1744284OtherHIGHMARK BLUE SHIELD
2882363OtherAETNA
3Y4595OtherPHS HEALTHNET
0182375604OtherAMERICHOICE
090312OtherPER CHOICE
PA0018237560005Medicaid
0087453000OtherKEYSTONE
10561OtherELDER HEALTH
30000233OtherKEYSTONE MERCY
090312OtherHORIZON BS
PA0018237560005Medicaid
PA090566Medicare PIN