Provider Demographics
NPI:1508934647
Name:FOGEL, DOV A (MD)
Entity Type:Individual
Prefix:
First Name:DOV
Middle Name:A
Last Name:FOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 MASSACHUSETTS AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1872
Mailing Address - Country:US
Mailing Address - Phone:617-547-6776
Mailing Address - Fax:
Practice Address - Street 1:1675 MASSACHUSETTS AVE STE 1B
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1872
Practice Address - Country:US
Practice Address - Phone:617-547-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1565392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry