Individual
DR. FORREST P OLD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
534 CARATOKE HWY, MOYOCK, NC 27958
(252) 435-6621
(252) 435-2685
Mailing address
667 KINGSBOROUGH SQ, STE 301, CHESAPEAKE, VA 23320-4999
(252) 435-6621
(252) 435-2685
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101037298
VA
207R00000X
Internal Medicine Physician
Primary
30443
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044739
ANTHEM
VA
01
—
62008
SENTARA
VA
05
—
8963991
—
NC
Enumeration date
09/14/2006
Last updated
04/27/2009
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