Provider Demographics
NPI:1093185019
Name:HOGUE, BRIDGET (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:HOGUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 FOULK RD 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2788
Mailing Address - Country:US
Mailing Address - Phone:302-661-7676
Mailing Address - Fax:302-661-1050
Practice Address - Street 1:1403 FOULK RD 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2788
Practice Address - Country:US
Practice Address - Phone:302-661-7676
Practice Address - Fax:302-661-1050
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001033363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant