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Individual

ANNA FOGG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSPT

Contact information

Practice address
303 FISHER RUN RD, BLOOMSBURG, PA 17815-7435
(570) 332-5280
(570) 332-5280
Mailing address
303 FISHER RUN RD, BLOOMSBURG, PA 17815-7435
(570) 332-5280

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT016699L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3689029
AETNA HMO PROVIDER #
PA
01
372926
HIGHMARK BS GROUP NO.
PA
01
50038611
CAPITAL BLUE CROSS #
PA
Enumeration date
07/03/2006
Last updated
03/25/2021
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