MEDICARE: DR. LESTER N. FOGELSANGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD427836	PA

General Provider Information

NPI Number	:	1881785442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESTER N. FOGELSANGER M.D.

Provider Business Mailing Address
First Line	:	1810 LIACOURAS WALK
Second Line	:	5TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-6026
Country	:	US
Telephone Number	:	215-204-7276
Fax Number	:	215-204-5419

Provider Business Practice Location Address
First Line	:	1810 LIACOURAS WALK
Second Line	:	5TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-6026
Country	:	US
Telephone Number	:	215-204-7276
Fax Number	:	215-204-5419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/30/2007

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