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NPI Code Detail

MEDICARE: DR. JEFFREY MITCHELL FOGEL MD

MEDICARE: DR. JEFFREY MITCHELL 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
1208000000XPediatrics PhysicianMD028946EPA

General Provider Information

NPI Number : 1639170079
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY MITCHELL FOGEL MD
Provider Business Mailing Address
First Line : 4308 HARBORWATCH LN
Second Line :
City : LUTZ
State : FL
Zip : 33558-9704
Country : US
Telephone Number : 813-949-1435
Fax Number :
Provider Business Practice Location Address
First Line : 2705 DEKALB PIKE
Second Line : SUITE 205
City : NORRISTOWN
State : PA
Zip : 19401-1852
Country : US
Telephone Number : 610-277-6400
Fax Number : 610-275-8861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/08/2007

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