Provider Demographics
NPI:1528547528
Name:FOGLE, ADAM SCOTT
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:SCOTT
Last Name:FOGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E ANTIETAM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5736
Mailing Address - Country:US
Mailing Address - Phone:301-733-2431
Mailing Address - Fax:
Practice Address - Street 1:322 E ANTIETAM ST STE 101
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5736
Practice Address - Country:US
Practice Address - Phone:301-733-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional