Provider Demographics
NPI:1154493658
Name:VOGAN, LAUREN HEATHER (PAC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:HEATHER
Last Name:VOGAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8115 OLD DOMINION DR
Mailing Address - Street 2:STE 220
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2324
Mailing Address - Country:US
Mailing Address - Phone:703-726-9930
Mailing Address - Fax:703-723-8283
Practice Address - Street 1:21785 FILIGREE COURT
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:703-726-9930
Practice Address - Fax:703-723-8283
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110002297Medicaid