Provider Demographics
NPI:1548295132
Name:FOGELMAN, ALAN M (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:FOGELMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-825-6058
Mailing Address - Fax:310-208-2870
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#214,365,530,420,120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-8811
Practice Address - Fax:310-208-2870
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-03-03
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Provider Licenses
StateLicense IDTaxonomies
CAA22560207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A225600Medicaid
CA00A225600Medicaid
CAA23143Medicare UPIN