Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OS017058 | PA |
NPI | 1306085972 |
---|---|
Provider Name | Dr. Albert Richard Fogle SR. |
First Address | Pittsburgh, PA 15224-1779 |
Second Address | Pittsburgh, PA 15224-1779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2009 |
Last Update Date | 20/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029134110001 | (05) | PA |