Provider Demographics
NPI:1831248905
Name:FOGT, CHAD JEREME (DO)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:JEREME
Last Name:FOGT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2449 ROSS MILLVILLE RD
Mailing Address - Street 2:STE B50
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-8952
Mailing Address - Country:US
Mailing Address - Phone:937-752-2306
Mailing Address - Fax:937-522-7626
Practice Address - Street 1:2449 ROSS MILLVILLE RD
Practice Address - Street 2:SUITE B50
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-8951
Practice Address - Country:US
Practice Address - Phone:513-737-6068
Practice Address - Fax:513-737-6681
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34008667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2769204Medicaid
OH2769204Medicaid