Fogarty, Jacqueline Mary

Fogarty, Jacqueline Mary is an sole proprietor health care provider with primary practice located at 409 Oak Ln , South Boston VA 24592-1633. She recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as her primary health care specialty. Fogarty, Jacqueline Mary can be contacted via phone (434) 572-8300.

Contact Information

Primary practice address
409 Oak Ln South Boston VA 24592-1633
Fax: (434) 572-1659
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 0101035912 Virginia

Profile Details

NPI number 1821051525
LBN Legal business name Fogarty, Jacqueline Mary
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 11th, 2006
Last updated Nov 18th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821051525 NPPES
Virginia MEDICAID 6401767
Virginia Other 078069
Virginia Other 200019809

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