Healthcare Provider Details

I. General information

NPI: 1548026784
Provider Name (Legal Business Name): BLAIRE LEIGH FOULGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 EWINGTOWN RD
CHURCH HILL MD
21623-1421
US

IV. Provider business mailing address

128 EWINGTOWN RD
CHURCH HILL MD
21623-1421
US

V. Phone/Fax

Practice location:
  • Phone: 443-480-6046
  • Fax:
Mailing address:
  • Phone: 443-480-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7611
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: