Physician Compare National (NPI:1639269954)

HEALTHCARE PROVIDER: JOANNE MARIE FOGARTY MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1639269954
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1658538426
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120209000640
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FOGARTY
	Individual professional last name
Provider First Name	JOANNE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NY UPSTATE MEDICAL UNIVERSITY
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PEDIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PEDIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	564 LOUDON RD
	Group Practice or individual's line 1 address
City	LATHAM
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	12110
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330013
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ALBANY MEDICAL CENTER HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y