1255057014 NPI number — SHEPHERD HEALTH SERVICES INC.

Table of content: LIVIA A. KOGAN PA (NPI 1114049053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255057014 NPI number — SHEPHERD HEALTH SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEPHERD HEALTH SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255057014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
852 QUINCE ORCHARD BLVD APT 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-1724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-661-1538
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
852 QUINCE ORCHARD BLVD APT 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-661-1538
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIGGIE
Authorized Official First Name:
OLIVIA
Authorized Official Middle Name:
DANSO
Authorized Official Title or Position:
MANAGER/ CEO
Authorized Official Telephone Number:
240-661-1538

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)