Healthcare Provider Details

I. General information

NPI: 1306085972
Provider Name (Legal Business Name): ALBERT RICHARD FOGLE SR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 FRIENDSHIP AVE SUITE 200
PITTSBURGH PA
15224-1779
US

IV. Provider business mailing address

4727 FRIENDSHIP AVE SUITE 200
PITTSBURGH PA
15224-1779
US

V. Phone/Fax

Practice location:
  • Phone: 412-235-5810
  • Fax: 412-235-5890
Mailing address:
  • Phone: 412-235-5810
  • Fax: 412-235-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS017058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: