Basic Information
Provider Information | |||||||||
NPI: | 1386905958 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FORREST | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | MILLER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MILLER | ||||||||
OtherFirstName: | REBECCA | ||||||||
OtherMiddleName: | ELLEN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 980509 | ||||||||
Address2: | IM: INTERNAL MEDICINE | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232980509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8048289726 | ||||||||
FaxNumber: | 8048284926 | ||||||||
Practice Location | |||||||||
Address1: | 417 N 11TH ST | ||||||||
Address2: | IM: INTERNAL MEDICINE | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232985002 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8048281941 | ||||||||
FaxNumber: | 8048280283 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/31/2012 | ||||||||
LastUpdateDate: | 12/28/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/28/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101255347 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.