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General NPI Number Information
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NPI Number | 1962513531
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Entity Type | Organization
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Legal Business Name | MARIA FOGATA MD PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 100 WEST AVENUE 210S
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City | JENKINTOWN
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State | PA
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Zip | 19046-2625
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Country | US
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Telephone | 215-726-3845
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Fax | 215-886-1053
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Provider Business Mailing Address
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Address Line | 100 WEST AVENUE 210S
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City | JENKINTOWN
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State | PA
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Zip | 19046-2625
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Country | US
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Telephone | 215-726-3845
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Fax | 215-886-1053
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Authorized Official
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Title or Position | OWNER
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Name | MARIA FOGATA
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Credential | M.D.
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Telephone | 215-726-3845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | MD 053767L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD 053767L
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License Number State | PA
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