Provider Demographics
NPI:1245221449
Name:HOGAN, PATRICK P (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:P
Last Name:HOGAN
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 1:121 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2429
Mailing Address - Country:US
Mailing Address - Phone:508-754-9100
Mailing Address - Fax:508-754-9101
Practice Address - Street 1:121 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2429
Practice Address - Country:US
Practice Address - Phone:508-754-9100
Practice Address - Fax:508-754-9109
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40875207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2051176Medicaid
MA2051176Medicaid
MAHO N01730Medicare ID - Type Unspecified