Provider Demographics
NPI:1962578377
Name:JOSEPH P FOGEL MD INC
Entity type:Organization
Organization Name:JOSEPH P FOGEL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNACCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-464-6200
Mailing Address - Street 1:824 BAY AVE
Mailing Address - Street 2:STE 70
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2104
Mailing Address - Country:US
Mailing Address - Phone:831-464-6200
Mailing Address - Fax:831-464-6204
Practice Address - Street 1:824 BAY AVE
Practice Address - Street 2:STE 70
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2104
Practice Address - Country:US
Practice Address - Phone:831-464-6200
Practice Address - Fax:831-464-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35774207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357740Medicaid
CAA27901Medicare UPIN
CA0268790001Medicare NSC
CAZZZ06274ZMedicare PIN