Individual
KENNETH W FOGARTY II
Active
Individual
KENNETH W FOGARTY II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
041118
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000679599C
—
GA
01
—
0400123
UNITED HEALTHCARE
GA
01
—
10053087
AMERIGROUP
GA
01
—
110225630
RR MEDICARE-GRP # CC4177
GA
01
—
336330
WELLCARE
GA
01
—
52542692
BCBS
GA
01
—
8583747
CIGNA
GA
Enumeration date
01/18/2006
Last updated
07/16/2013
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