Provider Demographics
NPI:1790735314
Name:FOGLEY, ANEES ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ANEES
Middle Name:ROBERT
Last Name:FOGLEY
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 1:802 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510
Mailing Address - Country:US
Mailing Address - Phone:570-347-8833
Mailing Address - Fax:570-344-4525
Practice Address - Street 1:802 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510
Practice Address - Country:US
Practice Address - Phone:570-347-8833
Practice Address - Fax:570-344-4525
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022007E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007492240001Medicaid
PA153782OtherBLUE CROSS BLUE SHIELD
PA0007492240001Medicaid
B40055Medicare UPIN