Provider Demographics
NPI:1306085972
Name:FOGLE, ALBERT RICHARD SR (DO)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:RICHARD
Last Name:FOGLE
Suffix:SR
Gender:M
Credentials:DO
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Mailing Address - Street 1:4727 FRIENDSHIP AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1779
Mailing Address - Country:US
Mailing Address - Phone:412-235-5810
Mailing Address - Fax:412-235-5890
Practice Address - Street 1:4727 FRIENDSHIP AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1779
Practice Address - Country:US
Practice Address - Phone:412-235-5810
Practice Address - Fax:412-235-5890
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2015-11-20
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Provider Licenses
StateLicense IDTaxonomies
PAOS017058207QG0300X
WV2435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029134110001Medicaid
PA351226NHMMedicare PIN