Basic Information
| Provider Information | |||||||||
| NPI: | 1427039239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOGLEMAN | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 694 GOOD DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443737 | ||||||||
| FaxNumber: | 7175443739 | ||||||||
| Practice Location | |||||||||
| Address1: | 694 GOOD DR | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176012433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175443737 | ||||||||
| FaxNumber: | 7175443739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 07/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | PAK000164 | PA | N | Other Service Providers | Acupuncturist | 207Q00000X | MD420579 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.