MEDICARE: DR. MARY O'HARA FOGLER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	02006514A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437646437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY O'HARA FOGLER DO

Provider Business Mailing Address
First Line	:	PO BOX 775383
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5383
Country	:	US
Telephone Number	:	812-376-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2118 25TH ST STE J
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3240
Country	:	US
Telephone Number	:	812-372-8426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	02/23/2026

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