Provider Demographics
NPI:1710996392
Name:FROGEL, JONATHAN K (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:K
Last Name:FROGEL
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 1:3400 SPRUCE STREET
Mailing Address - Street 2:3 DULLES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-349-8310
Mailing Address - Fax:
Practice Address - Street 1:51 N 39TH
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087344207L00000X
PAMD425969207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
JF087344OtherCHAMPUS-CHAMPUS
JF087344OtherCOMMERCIAL-COMMERCIAL NUMBER
MI488407610Medicaid
050H262180OtherBLUE CROSS-BLUE CROSS
050H262180OtherBLUE CROSS-BLUE CROSS
JF087344OtherCOMMERCIAL-COMMERCIAL NUMBER