Provider Demographics
NPI:1841851680
Name:FOGARTY, LAUREN PRICE (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:PRICE
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 ESTATE ENIGHED
Mailing Address - Street 2:PMB 311
Mailing Address - City:ST JOHN
Mailing Address - State:VI
Mailing Address - Zip Code:00830
Mailing Address - Country:US
Mailing Address - Phone:340-714-4270
Mailing Address - Fax:
Practice Address - Street 1:481-2 CHOCOLATE HOLE
Practice Address - Street 2:2D
Practice Address - City:ST. JOHN
Practice Address - State:VI
Practice Address - Zip Code:00830
Practice Address - Country:US
Practice Address - Phone:340-714-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI089363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical