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General NPI Number Information
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NPI Number | 1912802562
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Entity Type | Organization
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Legal Business Name | FOGGY BOTTOM PHYSICIAN GROUP INC.
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Dates
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Enumeration Date | 10/13/2026
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Last Update Date | 10/13/2026
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Provider Practice Location Address
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Address Line | 2150 PENNSYLVANIA AVE NW FL 6
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City | WASHINGTON
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State | DC
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Zip | 20037-3201
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Country | US
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Telephone | 202-741-3191
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Fax |
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Provider Business Mailing Address
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Address Line | 367 S GULPH RD
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3121
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | GARY SIMKUS
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Credential |
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Telephone | 610-382-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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