Provider Demographics
NPI:1053359836
Name:FOGARTIE, JAMES E JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:FOGARTIE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:
Practice Address - Street 1:3000 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1231
Practice Address - Country:US
Practice Address - Phone:919-350-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC115072086S0129X
NC97009512086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1065XOtherBLUE CROSS BLUE SHIELD
NCP00016340OtherMEDICARE RAILROAD
NC3752662OtherUNITEDHEALTHCARE
NC802153OtherPARTNERS MEDICARE
NC5636076OtherAETNA
NC891065XMedicaid
NCC6339OtherMEDCOST
NC2241379AMedicare ID - Type Unspecified
NC802153OtherPARTNERS MEDICARE