Provider Demographics
NPI:1376847475
Name:OGANS, MADISON E
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:E
Last Name:OGANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:E
Other - Last Name:OGANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:3501 S CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3916
Mailing Address - Country:US
Mailing Address - Phone:303-783-8844
Mailing Address - Fax:303-784-2002
Practice Address - Street 1:3501 S CLARKSON ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3916
Practice Address - Country:US
Practice Address - Phone:303-783-8844
Practice Address - Fax:303-784-2002
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1921363AM0700X
COPA.0003113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33331570Medicaid
CO33331570Medicaid