EVERETT ROY FORMAN M.D. NPI 1528061967

NPI Information

  • NPI: 1528061967
  • Provider Name: EVERETT ROY FORMAN, M.D.
  • Classification: General Practice - 208D00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • CLIA Number: 33D0709329
  • Address: 585 TROY SCHENECTADY RD
    LATHAM, NY
    ZIP 12110
  • Phone: (518) 785-6004

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NPI Details

Everett Roy Forman, M.D. is a general practice in Latham, NY with 58 years of experience. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee Everett Roy Forman, M.D. NPI is 1528061967. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: ALBANY MEDICAL COLLEGE OF UNION UNIVERSITY
Graduation Year:1968

The provider's business location address is:

585 TROY SCHENECTADY RD
LATHAM, NY
ZIP 12110-811
Phone: (518) 785-6004
Fax: (518) 785-1702

The NPI 1528061967 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The CLIA number assigned to this NPI record is 33D0709329 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Established patient office or other outpatient visit, 30-39 minutes (HCPCS:99214)
  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
  • Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit (HCPCS:G0439)
  • Urinalysis, manual test (HCPCS:81002)

The enumeration date for this NPI number is 5/31/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208D00000XGeneral Practice103928-1NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
101148OTHERMVP
210000672OTHERCDPHP
349E991OTHEREMPIRE BCBS
4000401336001OTHERBLUE SHIELD OF NENY
555078AMEDICARE ID-TYPE UNSPECIFIED
6D02266MEDICARE UPINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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