NPIMap

Organization Active NPI

Nicholas Fogelson MD LLC

  • Gynecology Physician
  • Portland, OR
National Provider Identifier
1316436785
Registry record updated Jul 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
173545 Issued in OR
Legal business name
NICHOLAS FOGELSON MD LLC
Practice address
511 SW 10TH Ave Ste 907
Portland, OR 97205-2710
Phone
(503) 715-1377
Fax
(503) 771-2717
NPI assigned
May 1, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Nicholas S Fogelson, MDNPI 1194708081
Title
Medical Director
Phone
(503) 715-1377

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207VG0400X 173545 OR Primary

Addresses

Primary practice location

511 SW 10TH Ave Ste 907
Portland, OR 97205-2710

Mailing address

511 SW 10TH Ave Ste 907
Portland, OR 97205-2710
Phone (503) 715-1377

Other names 1

  • NORTHWEST ENDOMETRIOSIS AND PELVIC SURGERY Doing business as

National Provider Directory

National Provider Directory

Locations

511 SW 10th Ave
Ste 907
Portland, OR 97205
Phone (503) 715-1377

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625443200000",
    "number": "1316436785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "511 SW 10TH AVE STE 907",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052710",
            "telephone_number": "503-715-1377",
            "fax_number": "503-771-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 SW 10TH AVE STE 907",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052710",
            "telephone_number": "503-715-1377",
            "fax_number": "503-771-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICHOLAS FOGELSON MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-01",
        "last_updated": "2021-07-05",
        "certification_date": "2021-07-05",
        "status": "A",
        "authorized_official_last_name": "FOGELSON",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "503-715-1377",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "OR",
            "license": "173545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHWEST ENDOMETRIOSIS AND PELVIC SURGERY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.