Provider Demographics
NPI:1871719047
Name:FOGELMAN, CHARLES J (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:FOGELMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 S MANSION DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4112
Mailing Address - Country:US
Mailing Address - Phone:301-587-0005
Mailing Address - Fax:
Practice Address - Street 1:1009 S MANSION DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4112
Practice Address - Country:US
Practice Address - Phone:301-587-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1007103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist