Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jake Forman

Individual provider Vascular Surgery Physician · NPI 1558721167

Jake Forman is a Vascular Surgery in York, Pennsylvania. Qualified in 2016, 10 years ago. Practices with Wellspan Medical Group, a 2,342-clinician group, works from 4 locations, accepts Medicare assignment and offers telehealth. Licensed in Pennsylvania.

Years since qualifying
10
Licensed in
PA
In the registry since
2016
Specialties on file
2
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Practice location Address checks out

30 Monument Rd Ste 1100
York, PA 17403-5024
Phone: (717) 851-6454
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 1227 Baltimore St, Hanover, PA 17331-4406 — (717) 851-6454
  • 30 Monument Rd Ste 1100, York, PA 17403-5024 — (717) 812-2480
  • 325 S Belmont St, York, PA 17403-2608 — (717) 843-8623

Specialties & licences

Vascular Surgery Physician (primary) Taxonomy 2086S0129X · Licence OS019891 (PA)
Vascular Surgery Physician Taxonomy 2086S0129X · Licence FF2923515 (PA)

Record details

NPI number1558721167
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 25, 2016
Last updated in NPPESMay 14, 2026
Certification dateMay 14, 2026
Mailing address601 Memory Ln, York, PA 17402-2231

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyVASCULAR SURGERY
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Wellspan Medical Group — 2342 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in York