Provider Demographics
NPI:1184754343
Name:FOGEL, BARUCH (MD)
Entity type:Individual
Prefix:DR
First Name:BARUCH
Middle Name:
Last Name:FOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 MICHELSON DR
Mailing Address - Street 2:SUITE 735
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-0625
Mailing Address - Country:US
Mailing Address - Phone:949-260-6503
Mailing Address - Fax:949-567-0202
Practice Address - Street 1:3333 MICHELSON DR
Practice Address - Street 2:SUITE 735
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-0625
Practice Address - Country:US
Practice Address - Phone:949-260-6503
Practice Address - Fax:949-567-0202
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE64816Medicare UPIN