Provider Demographics
NPI:1881637312
Name:FOGARTY, JANINE L (MD)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:L
Last Name:FOGARTY
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 1:1555 LONG POND RD
Mailing Address - Street 2:PALLIATIVE CARE MEDICINE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7870
Mailing Address - Fax:585-723-7871
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:PALLIATIVE CARE MEDICINE
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7870
Practice Address - Fax:585-723-7871
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1960042085H0002X, 2085H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085H0002XAllopathic & Osteopathic PhysiciansRadiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01506225Medicaid
NYJ400314962-GRPBA0017Medicare PIN
NY01506225Medicaid
NYRB7741Medicare PIN