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General NPI Number Information
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NPI Number | 1174557151
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Entity Type | Individual
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Provider Name | JOHN P FOGARTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 28 CENTRE DR
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City | MILTON
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State | VT
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Zip | 05468-3104
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Country | US
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Telephone | 802-847-4322
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Fax |
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Provider Business Mailing Address
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Address Line | 182 YACHT HAVEN DR
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City | SHELBURNE
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State | VT
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Zip | 05482-7774
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Country | US
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Telephone | 802-985-2755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | VT
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