Provider Demographics
NPI:1982654794
Name:FUGATE, ANGELIQUE MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:MARIE
Last Name:FUGATE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:ALBURTIS
Mailing Address - State:PA
Mailing Address - Zip Code:18011-9596
Mailing Address - Country:US
Mailing Address - Phone:610-966-2892
Mailing Address - Fax:
Practice Address - Street 1:244 MAPLE CT
Practice Address - Street 2:
Practice Address - City:ALBURTIS
Practice Address - State:PA
Practice Address - Zip Code:18011-9596
Practice Address - Country:US
Practice Address - Phone:610-966-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005706213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist