Basic Information
| Provider Information | |||||||||
| NPI: | 1861754855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORSTHOEFEL | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | WALTER REED NATIONAL MILITARY CTR | ||||||||
| Address2: | 8901 WISCONSIN AVENUE | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208895600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012950196 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WALTER REED NATIONAL MILITARY CTR | ||||||||
| Address2: | 8901 WISCONSIN AVENUE | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208895600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012950196 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2012 | ||||||||
| LastUpdateDate: | 01/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35123882 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.