Provider Demographics
NPI:1295985653
Name:FOGARTY, KELLI ANN
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-3334
Mailing Address - Country:US
Mailing Address - Phone:610-987-8277
Mailing Address - Fax:
Practice Address - Street 1:1111 COMMONS BLVD.
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-6050
Practice Address - Country:US
Practice Address - Phone:610-987-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist