Provider Demographics
NPI:1437123551
Name:HOGAN, ELIZABETH HART (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HART
Last Name:HOGAN
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 1:60 EAST ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-4500
Mailing Address - Country:US
Mailing Address - Phone:197-868-7635
Mailing Address - Fax:197-868-9735
Practice Address - Street 1:60 EAST ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4500
Practice Address - Country:US
Practice Address - Phone:978-687-6355
Practice Address - Fax:978-689-7353
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17419363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA24263OtherHARVARD PILGRIM
MA0702242Medicaid
MANP9735OtherBLUE CROSS
MA0702242Medicaid