License holder summary

LANNY PHILIP FORMAN is a Medical Physician And Surgeon licensed to practice in Pennsylvania. The address on file for LANNY PHILIP FORMAN is Philadelphia PA 19131. This medical practitioner license is not current. The license was granted 05/21/1976 and expired on 12/31/2014.

Department of State

Board of Medicine

LANNY PHILIP FORMAN
Medical Physician And Surgeon
License number
MD017738E
Date granted
05/21/1976
Date expires
12/31/2014
Class
Medical Physician And Surgeon
Status
Inactive
Address
Philadelphia PA 19131
medicinepa.com
ID 37608209
LAST UPDATED 2024-01-25 08:39:23 UTC

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