Provider Demographics
NPI:1245221951
Name:FOGLE, RHONDA S (MD, CM)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:S
Last Name:FOGLE
Suffix:
Gender:F
Credentials:MD, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-0381
Mailing Address - Country:US
Mailing Address - Phone:978-664-6868
Mailing Address - Fax:978-664-8690
Practice Address - Street 1:50 TREMONT ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2721
Practice Address - Country:US
Practice Address - Phone:781-665-8600
Practice Address - Fax:781-665-5532
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44131208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9722238Medicaid
F02091Medicare UPIN
B40076Medicare ID - Type Unspecified