Healthcare Provider Details

I. General information

NPI: 1568573020
Provider Name (Legal Business Name): MARY DOROTHY FOGERTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 MEDICAL CENTER DRIVE 11 SOUTH VUH
NASHVILLE TN
37212
US

IV. Provider business mailing address

1211 21ST AVENUE S. 404 MEDICAL ARTS BUILDING
NASHVILLE TN
37212-1750
US

V. Phone/Fax

Practice location:
  • Phone: 615-936-0182
  • Fax: 615-936-0185
Mailing address:
  • Phone: 615-936-0182
  • Fax: 615-936-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0000037962
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: