Healthcare Provider Details

I. General information

NPI: 1346407137
Provider Name (Legal Business Name): KELLY A FOGLEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 LENDEW ST
GREENSBORO NC
27408-7007
US

IV. Provider business mailing address

PO BOX 9577
GREENSBORO NC
27429-0577
US

V. Phone/Fax

Practice location:
  • Phone: 336-273-2835
  • Fax:
Mailing address:
  • Phone: 336-273-2835
  • Fax: 336-273-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number2008-00429
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: