Individual
CAROLYN JEAN FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.M.D.
Contact information
Practice address
64 SOMERSET BLVD, CHARLES TOWN, WV 25414-4827
(304) 728-5066
(304) 728-5074
Mailing address
110 BROOKLAND CT APT 12, WINCHESTER, VA 22602-6181
(540) 550-0306
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
96196
WV
Other
Enumeration date
09/04/2007
Last updated
09/04/2007
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