1578640207 NPI number — MR. MICHAEL TODD KOGAN CP, BOCO

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578640207 NPI number — MR. MICHAEL TODD KOGAN CP, BOCO

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KOGAN

Provider First Name:

MICHAEL

Provider Middle Name:

TODD

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

CP, BOCO

Provider Gender Code:

M

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:

1578640207

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1547 BITTERSWEET CIR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

JAMISON

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18929-1429

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1547 BITTERSWEET CIR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

JAMISON

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18929-1429

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

267-614-1538

Provider Business Practice Location Address Fax Number:

267-897-9055

Provider Enumeration Date:

11/01/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0002035000 . This is a "AMERIHEALTH HEALTH PLANS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0002035000 . This is a "AMERIHEALTH HMO, INC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0002035000 . This is a "PERSONAL CHOICE 65" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0002035000 . This is a "KEYSTONE HEALTHPLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2035 . This is a "TRADITIONAL INDEMNITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2035 . This is a "BLUE CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 3753541 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0002035000 . This is a "KEYSTONE POS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1012223920001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0002035000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2035 . This is a "AMERIHEALTH INSURANCE CO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0002035000 . This is a "KEYSTONE 65" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".