Healthcare Provider Details

I. General information

NPI: 1003015272
Provider Name (Legal Business Name): ELIZABETH FOGLIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 8 RAVDIN
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST 8 RAVDIN
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3228
  • Fax: 215-349-8831
Mailing address:
  • Phone: 215-662-3228
  • Fax: 215-349-8831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD434705
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: