Provider Demographics
NPI:1730939554
Name:FOGLEMAN, KANDIS MCNEIL (MD)
Entity type:Individual
Prefix:
First Name:KANDIS
Middle Name:MCNEIL
Last Name:FOGLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANDIS
Other - Middle Name:RAE
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1920 W 1ST ST FL 3
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4220
Mailing Address - Country:US
Mailing Address - Phone:336-716-4479
Mailing Address - Fax:
Practice Address - Street 1:1920 W 1ST ST FL 3
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4220
Practice Address - Country:US
Practice Address - Phone:336-716-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program