Provider Demographics
NPI:1649552225
Name:FOGEL, MICHAEL PAUL (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:FOGEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SPOTSYLVANIA PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7762
Mailing Address - Country:US
Mailing Address - Phone:540-498-4900
Mailing Address - Fax:
Practice Address - Street 1:4600 SPOTSYLVANIA PKWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7762
Practice Address - Country:US
Practice Address - Phone:540-498-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008112363A00000X
VA0110003668363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant