Provider Demographics
NPI:1548026784
Name:FOULGER, BLAIRE LEIGH
Entity type:Individual
Prefix:
First Name:BLAIRE
Middle Name:LEIGH
Last Name:FOULGER
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 1:128 EWINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHURCH HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21623-1421
Mailing Address - Country:US
Mailing Address - Phone:443-480-6046
Mailing Address - Fax:
Practice Address - Street 1:128 EWINGTOWN RD
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:MD
Practice Address - Zip Code:21623-1421
Practice Address - Country:US
Practice Address - Phone:443-480-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7611124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist