Provider Demographics
NPI:1922007160
Name:FOGLE, ALAN W (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:W
Last Name:FOGLE
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:125 DOUGHTY ST STE 280
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5727
Practice Address - Country:US
Practice Address - Phone:843-884-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97460208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00930468OtherRAILROAD MEDICARE ID-RSFPN
SC97460Medicaid
SCAA50599223Medicare PIN
SCP00930468OtherRAILROAD MEDICARE ID-RSFPN
SCD99269Medicare UPIN
SCD992698519Medicare PIN