MEDICARE: MRS. SARI N FOGEL MD

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	2084P0800X	Psychiatry Physician	MD033004E	PA

General Provider Information

NPI Number	:	1548341043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARI N FOGEL MD

Provider Business Mailing Address
First Line	:	146 MONTGOMERY AVE
Second Line	:	SUITE 301
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2956
Country	:	US
Telephone Number	:	215-735-3540
Fax Number	:	610-668-1902

Provider Business Practice Location Address
First Line	:	146 MONTGOMERY AVE
Second Line	:	SUITE 301
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2956
Country	:	US
Telephone Number	:	215-735-3540
Fax Number	:	610-668-1902

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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