Provider Demographics
NPI:1134107964
Name:OGAGAN, PIUS FOVIE (MD)
Entity Type:Individual
Prefix:
First Name:PIUS
Middle Name:FOVIE
Last Name:OGAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:HALLMARK HEALTH SYSTEM INC SUITE 116
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4540
Mailing Address - Country:US
Mailing Address - Phone:781-396-2000
Mailing Address - Fax:781-391-2619
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:HALLMARK HEALTH SYSTEM INC SUITE 116
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4540
Practice Address - Country:US
Practice Address - Phone:781-396-2000
Practice Address - Fax:781-391-2619
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ29552OtherBLUE CROSS LEGACY NUMBER
MA2111691Medicaid
MAA39430Medicare PIN