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NPI Code Detail

MEDICARE: DR. MARGO L. FUGATE MD

MEDICARE: DR. MARGO L. FUGATE 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
12084P0804XChild & Adolescent Psychiatry Physician61909CT

Other Identifiers

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

General Provider Information

NPI Number : 1568578227
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARGO L. FUGATE MD
Provider Business Mailing Address
First Line : 400 COLUMBUS AVENUE
Second Line : CREDENTIALING SPECIALIST
City : NEW HAVEN
State : CT
Zip : 06519-1233
Country : US
Telephone Number : 203-503-3174
Fax Number : 203-503-3183
Provider Business Practice Location Address
First Line : 226 DIXWELL AVENUE
Second Line : CFG-DIXWELL
City : NEW HAVEN
State : CT
Zip : 06511-3456
Country : US
Telephone Number : 203-503-3458
Fax Number : 203-503-3451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 10/04/2018

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