Organization
FOGGY BOTTOM PHYSICIAN GROUP, INC.
Active
Organization
FOGGY BOTTOM PHYSICIAN GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY RODRIGUEZ (COO)
(610) 382-3397
Entity
Organization
Contact information
Practice address
1500 N BEAUREGARD STREET, SUITE 100, ALEXANDRIA, VA 22311-1715
(833) 694-9362
Mailing address
367 S GULPH RD, KING OF PRUSSIA, PA 19406-3121
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
08/05/2026
Last updated
08/05/2026
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