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General NPI Number Information
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NPI Number | 1285669341
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Entity Type | Individual
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Provider Name | BRIAN KIRBY FOGARTY MED
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 426 S THIRD ST STE 201
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City | LEMOYNE
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State | PA
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Zip | 17043
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Country | US
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Telephone | 717-737-2448
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Fax | 717-774-1435
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Provider Business Mailing Address
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Address Line | 352 FUTURITY DR
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City | CAMP HILL
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State | PA
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Zip | 17011
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Country | US
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Telephone | 717-774-1218
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS004024L
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License Number State | PA
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