Provider Demographics
NPI:1790717619
Name:FOX, MICHELLE C (MD)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:C
Last Name:FOX
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 1:162 BERKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-4638
Mailing Address - Country:US
Mailing Address - Phone:443-386-5555
Mailing Address - Fax:
Practice Address - Street 1:162 BERKLEY AVE
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-4638
Practice Address - Country:US
Practice Address - Phone:443-386-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59967207V00000X
NJ25MA09656500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402127400Medicaid
MD145400Y86Medicare PIN
MD402127400Medicaid