Provider Demographics
NPI:1821379082
Name:NATALIE FOGELSON PLLC
Entity Type:Organization
Organization Name:NATALIE FOGELSON PLLC
Other - Org Name:CORAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:CHANTALL
Authorized Official - Last Name:FOGELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-614-5461
Mailing Address - Street 1:PO BOX 3635
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2561
Mailing Address - Country:US
Mailing Address - Phone:928-639-0166
Mailing Address - Fax:928-639-0167
Practice Address - Street 1:4025 W BELL RD STE 22
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2749
Practice Address - Country:US
Practice Address - Phone:623-580-9323
Practice Address - Fax:623-580-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5298332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6479410001Medicare NSC