Provider Demographics
NPI:1902945801
Name:RIDDLE, FORREST ALTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:FORREST
Middle Name:ALTON
Last Name:RIDDLE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:7817 HALEHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1044
Mailing Address - Country:US
Mailing Address - Phone:410-551-8212
Mailing Address - Fax:301-688-3900
Practice Address - Street 1:9800 SAVAGE RD
Practice Address - Street 2:
Practice Address - City:FORT GEORGE G MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5999
Practice Address - Country:US
Practice Address - Phone:301-688-7264
Practice Address - Fax:301-688-3900
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MDD0055596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine