Healthcare Provider Details

I. General information

NPI: 1205829686
Provider Name (Legal Business Name): MARK ANTHONY FOGLIETTI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22901 MILLCREEK BLVD SUITE 145
BEACHWOOD OH
44122-5728
US

IV. Provider business mailing address

22901 MILLCREEK BLVD SUITE 145
BEACHWOOD OH
44122-5728
US

V. Phone/Fax

Practice location:
  • Phone: 216-292-6800
  • Fax: 216-292-7775
Mailing address:
  • Phone: 216-292-6800
  • Fax: 216-292-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number34003551F
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: