Healthcare Provider Details

I. General information

NPI: 1699066548
Provider Name (Legal Business Name): WILLIAM ALBERT FOGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 07/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST EMERGENCY DEPARTMENT
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

418 1/2 COLEGATE DRIVE
MARIETTA OH
45750-9549
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-1939
  • Fax: 740-374-1693
Mailing address:
  • Phone: 740-374-4500
  • Fax: 740-374-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-122529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: