Provider Demographics
NPI:1164046421
Name:HOGAN, LAURA (CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:AGUADO PICKERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1302 MACTON RD
Mailing Address - Street 2:
Mailing Address - City:STREET
Mailing Address - State:MD
Mailing Address - Zip Code:21154-1511
Mailing Address - Country:US
Mailing Address - Phone:706-577-2557
Mailing Address - Fax:
Practice Address - Street 1:520 UPPER CHESAPEAKE DR STE 301
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4375
Practice Address - Country:US
Practice Address - Phone:443-643-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR238061367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife