Individual
MR. SCOTT IAN FORMAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
8200 HENRY AVE, SUITE G-1, PHILADELPHIA, PA 19128-2984
(215) 482-2336
(215) 483-4389
Mailing address
1500 LANSDOWNE AVE, DARBY, PA 19023-1200
(215) 482-2336
(215) 483-4389
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
05012386
PA
208M00000X
Hospitalist Physician
Primary
OS012386
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101139948000
—
PA
01
—
1623935
BLUE SHIELD
PA
Enumeration date
07/29/2005
Last updated
01/30/2019
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