Active NPI
Douglas Lloyd Fogel, PSY.D.
- Clinical Psychologist
- Baltimore, MD
National Provider Identifier
1144583576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 03974
- Practice address
- 711 W 40TH St
Suite 456B
Baltimore, MD 21211-2120 - Phone
- (202) 669-3825
- NPI assigned
- Jun 20, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 03974 | MD | Primary |
Addresses
Primary practice location
711 W 40TH St
Suite 456B
Baltimore, MD 21211-2120
Mailing address
321 Penwood Rd
Silver Spring, MD 20901-2717
Phone (202) 669-3825
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2016 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03974 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340150400000",
"number": "1144583576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 PENWOOD RD",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209012717",
"telephone_number": "202-669-3825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 W 40TH ST",
"address_2": "SUITE 456B",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212112120",
"telephone_number": "202-669-3825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOGEL",
"first_name": "DOUGLAS",
"middle_name": "LLOYD",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-20",
"last_updated": "2012-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "03974",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.