Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD043666E | PA |
Y | 2080P0202X | Pediatric Cardiologist | MD043666E | PA |
NPI | 1164454971 |
---|---|
Provider Name | Mark A Fogel |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 16/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001300843 | (05) | PA |
5255201 | (05) | NJ |
F39967 | (02) |