Provider Demographics
NPI:1366631384
Name:COGAN, MELANIE E (NP)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:E
Last Name:COGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 911
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302
Mailing Address - Country:US
Mailing Address - Phone:207-303-3200
Mailing Address - Fax:207-303-2140
Practice Address - Street 1:2 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6078
Practice Address - Country:US
Practice Address - Phone:207-303-3300
Practice Address - Fax:207-250-2144
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH086926-23363L00000X
MER043738363LA2200X
MECNP81888363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433805099Medicaid
MEP01304470OtherRAILROAD MEDICARE
NH3098785Medicaid