Provider Demographics
NPI:1689787079
Name:FOUGY, GHISLAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GHISLAINE
Middle Name:
Last Name:FOUGY
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 1:10230 NEW HAMPSHIRE AVE
Mailing Address - Street 2:#202
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1400
Mailing Address - Country:US
Mailing Address - Phone:301-431-2500
Mailing Address - Fax:410-848-8202
Practice Address - Street 1:10230 NEW HAMPSHIRE AVE
Practice Address - Street 2:#202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1400
Practice Address - Country:US
Practice Address - Phone:301-431-2500
Practice Address - Fax:301-439-5927
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00182512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD131181600Medicaid
MD057258Medicare ID - Type Unspecified
B93028Medicare UPIN