Individual
KACEY LYNN FOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
345 SAINT PAUL PL, BALTIMORE, MD 21202-2123
(410) 332-9000
Mailing address
345 ST.PAUL PLACE, BALTIMORE, MD 21202-6502
(410) 332-9000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C05221
MD
Other
Enumeration date
09/20/2013
Last updated
08/31/2015
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