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General NPI Number Information
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NPI Number | 1316919194
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Entity Type | Individual
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Provider Name | CHARLES M FOGARTY MD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 2030 N CHURCH PLACE
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City | SPARTANBURG
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State | SC
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Zip | 29303
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Country | US
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Telephone | 864-558-2685
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Fax | 864-585-0999
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Provider Business Mailing Address
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Address Line | PO BOX 4276
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City | SPARTANBURG
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State | SC
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Zip | 29305
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Country | US
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Telephone | 864-582-6858
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Fax | 864-585-0999
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 8691
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License Number State | SC
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