Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 030630 | CT |
NPI | 1003815887 |
---|---|
Provider Name | Mitchell Andrew Fogel |
First Address | Bridgeport, CT 06606-5534 |
Second Address | Bridgeport, CT 06606-5534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 09/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001306308 | (05) | CT |
D87869 | (02) | CT |