Provider Demographics
NPI:1235109828
Name:HOGAN, TIMOTHY J (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:HOGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:265 W UNION ST
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2313
Practice Address - Country:US
Practice Address - Phone:740-594-2456
Practice Address - Fax:740-594-9630
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005731208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5619197341A11OtherBLUECROSS BLUESHIELD
OH0934341Medicaid
OHH152630Medicare PIN
F43753Medicare UPIN