Healthcare Provider Details

I. General information

NPI: 1427039239
Provider Name (Legal Business Name): COREY FOGLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 GOOD DR SUITE 11
LANCASTER PA
17601-2433
US

IV. Provider business mailing address

694 GOOD DR SUITE 11
LANCASTER PA
17601-2433
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3737
  • Fax: 717-544-3739
Mailing address:
  • Phone: 717-544-3737
  • Fax: 717-544-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberPAK000164
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD420579
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: