Provider Demographics
NPI:1295870186
Name:FUGATE, TOBY L (DO)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:L
Last Name:FUGATE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:843-724-2454
Practice Address - Street 1:1481 TOBIAS GADSON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4879
Practice Address - Country:US
Practice Address - Phone:843-402-3093
Practice Address - Fax:843-402-1094
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO000367207RI0200X
SC1091207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC010918Medicaid
LA342350YH58Medicare PIN
SCAA2282Medicare PIN
SCO10918Medicaid