Provider Demographics
NPI:1326005349
Name:HOGAN, MARION P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:P
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:STE 418
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-868-4928
Mailing Address - Fax:617-868-2513
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:STE 418
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-868-4928
Practice Address - Fax:617-868-2513
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210303207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3036219Medicaid
MAJ07361Medicare ID - Type Unspecified
MA3036219Medicaid