Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 13367 | HI |
N | 207V00000X | Obstetrician & Gynecologist | 23610 | SC |
Y | 207VG0400X | Gynecologist | 173545 | OR |
NPI | 1194708081 |
---|---|
Provider Name | Dr. Nicholas S. Fogelson |
First Address | Portland, OR 97205-2710 |
Second Address | Portland, OR 97205-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 06/07/2021 |