Provider Demographics
NPI:1437646437
Name:FOGLER, MARY O'HARA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:O'HARA
Last Name:FOGLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:O'HARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:703 E. KESSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240
Mailing Address - Country:US
Mailing Address - Phone:219-263-8735
Mailing Address - Fax:
Practice Address - Street 1:718 N. LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1348
Practice Address - Country:US
Practice Address - Phone:812-222-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006514A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300054316Medicaid