Ivis Theodore Forrester, PH.D., RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

D02016 Issued in MD

Practice address

3939 Reisterstown Rd
Baltimore, MD 21251

Phone

(410) 367-7821

Fax

(410) 367-7823

NPI assigned

Aug 5, 2011

Last updated

Aug 5, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• ABA Health Services Counseling

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Baltimore, MD
  • NPI 1649593245
  NPD (past)
• ABA Health Services Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
  • NPI 1720019672
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312502400000",
    "number": "1437438645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 GLEN FALLS RD",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "21136",
            "telephone_number": "410-833-3682",
            "fax_number": "410-833-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 REISTERSTOWN RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21251",
            "telephone_number": "410-367-7821",
            "fax_number": "410-367-7823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORRESTER",
        "first_name": "IVIS",
        "middle_name": "THEODORE",
        "name_prefix": "Dr.",
        "credential": "PH.D., RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-05",
        "last_updated": "2011-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MD",
            "license": "D02016",
            "primary": true
        },
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "MD",
            "license": "D02016",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arash Foroughi, M.D.
• Iman Foroughmand, MD
• Alexandra Derusso Forrest, MD
• Iain S. Forrest, M.D., PH.D.
• Madison Forrest
• Lisa Forrester, MS, CCC-SLP
• Stephen Michael Forrester, LGSW
• Danielle Forrey, LCSW-C
• Jonathan Agner Forsberg
• Shajuan M Forsey

• Registered Dietitian in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Registered Dietitian in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.