Individual
WILLIAM R FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
100 E LANCASTER AVE, SUITE 117, WYNNEWOOD, PA 19096-3450
(610) 649-9662
Mailing address
100 E LANCASTER AVE, SUITE 117, WYNNEWOOD, PA 19096-3450
(610) 649-9662
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC002073L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0048233000
KEYSTONE
PA
05
—
0540513
—
PA
01
—
307800
HMA
PA
01
—
31701
MERCY
PA
01
—
987921
AMA HEALTH
PA
Enumeration date
10/03/2005
Last updated
10/15/2007
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