Healthcare Provider Details

I. General information

NPI: 1841851680
Provider Name (Legal Business Name): LAUREN PRICE FOGARTY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MAIN ST
WESTPORT CT
06880-2441
US

IV. Provider business mailing address

315 MAIN ST
WESTPORT CT
06880-2441
US

V. Phone/Fax

Practice location:
  • Phone: 203-935-8454
  • Fax:
Mailing address:
  • Phone: 203-935-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number089
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7390
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number035613
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: