Healthcare Provider Details

I. General information

NPI: 1831367507
Provider Name (Legal Business Name): MARK A. FOGLIETTI DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22901 MILLCREEK BLVD STE 145
BEACHWOOD OH
44122-5724
US

IV. Provider business mailing address

275 SPRINGSIDE DR STE 100
AKRON OH
44333-4549
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK A FOGLIETTI
Title or Position: PRESIDENT
Credential: DO
Phone: 216-292-6800