Provider Demographics
NPI:1417136607
Name:CLIFFORD VOGAN MD PC
Entity Type:Organization
Organization Name:CLIFFORD VOGAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:VOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-548-7909
Mailing Address - Street 1:882 E BRADY RD
Mailing Address - Street 2:
Mailing Address - City:COWANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16218-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:882 E BRADY RD
Practice Address - Street 2:
Practice Address - City:COWANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16218-1316
Practice Address - Country:US
Practice Address - Phone:724-548-7909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021896E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherTAX ID