Provider Demographics
NPI:1407966377
Name:VOGELSANG, PHILIP JOHN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:VOGELSANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 JANES RD
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4742
Mailing Address - Country:US
Mailing Address - Phone:707-822-7220
Mailing Address - Fax:707-826-8284
Practice Address - Street 1:3800 JANES RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4742
Practice Address - Country:US
Practice Address - Phone:707-822-3621
Practice Address - Fax:707-826-1342
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22800083207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G593630OtherINDIVIDUAL PROVIDER #
CA220011353OtherRAILROAD MEDIA
CA00G93631Medicare PIN