Provider Demographics
NPI:1417941808
Name:FOGEL, ERIN S (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:S
Last Name:FOGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PILLSBURY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3502
Mailing Address - Country:US
Mailing Address - Phone:603-228-1104
Mailing Address - Fax:603-228-7061
Practice Address - Street 1:2 PILLSBURY ST STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3502
Practice Address - Country:US
Practice Address - Phone:603-228-1104
Practice Address - Fax:603-228-7061
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9218207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0109730Y0NH01OtherANTHEM NH
NH9666977001Other9666977001
NH300007003Medicaid
NH180023894Other180023894
NH300007003Medicaid
NHRE3188Medicare PIN
NH0141110001Medicare NSC