Organization
JACQUELINE M FOGARTY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE M FOGARTY MD (PRESIDENT/OWNER)
(434) 572-8300
Entity
Organization
Contact information
Practice address
409 OAK LN, SOUTH BOSTON, VA 24592-1633
(434) 572-8300
(434) 572-1659
Mailing address
409 OAK LN, SOUTH BOSTON, VA 24592-1633
(434) 572-8300
(434) 572-1659
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101035912
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6401767
—
VA
Enumeration date
03/15/2012
Last updated
03/15/2012
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