Provider Demographics
NPI:1992343099
Name:FORCH, MARY (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FORCH
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15245 SHADY GROVE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7201
Mailing Address - Country:US
Mailing Address - Phone:301-869-9776
Mailing Address - Fax:301-417-4947
Practice Address - Street 1:2639 CONNECTICUT AVE NW STE C100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1593
Practice Address - Country:US
Practice Address - Phone:202-588-1878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1056317363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health