Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | 2305214700 | VA |
N | 213ES0000X | Sports Medicine | 2305214700 | VA |
Y | 2081S0010X | Sports Medicine | PT5000023 | DC |
Y | 213ES0000X | Sports Medicine | PT5000023 | DC |
NPI | 1457022329 |
---|---|
Provider Name | Dr. Salvatore J Fogarino III |
First Address | Arlington, VA 22201-4766 |
Second Address | Washington, DC 20006-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 23/11/2021 |