Individual
DR. JACQUELINE MARY FOGARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
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
01
—
078069
ANTHEM
VA
01
—
200019809
RAILROAD MEDICARE
VA
05
—
6401767
—
VA
Enumeration date
04/11/2006
Last updated
11/18/2010
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