Provider Demographics
NPI:1295140721
Name:FOGARTY, MONICA WARDWELL (MD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:WARDWELL
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:ANN
Other - Last Name:WARDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 SIMON AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3743
Mailing Address - Country:US
Mailing Address - Phone:409-791-8863
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE STE 14000
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8738208M00000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program