Provider Demographics
NPI:1780643676
Name:FOGLIA, GINAMARIE (DO)
Entity Type:Individual
Prefix:
First Name:GINAMARIE
Middle Name:
Last Name:FOGLIA
Suffix:
Gender:F
Credentials:DO
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Other - Last Name:
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Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MANAGEMENT - PROFESSIONAL BUILDING
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4969
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:500 PLAZA CT
Practice Address - Street 2:SUITE D
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8262
Practice Address - Country:US
Practice Address - Phone:570-476-3778
Practice Address - Fax:570-421-3493
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013351207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014274240001Medicaid
PA096069LJYMedicare ID - Type Unspecified
I45742Medicare UPIN