Basic Information
| Provider Information | |||||||||
| NPI: | 1669434742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORBESS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 W REDWOOD ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6672141720 | ||||||||
| FaxNumber: | 4107066976 | ||||||||
| Practice Location | |||||||||
| Address1: | 419 W REDWOOD ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212017003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6672141718 | ||||||||
| FaxNumber: | 4103285147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 036141439 | IL | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 060994302 | 05 | TX | MEDICAID |