Provider Demographics
NPI:1447221809
Name:COGEN, LORNA A (MD)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:A
Last Name:COGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 VALE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3834
Mailing Address - Country:US
Mailing Address - Phone:510-215-9930
Mailing Address - Fax:510-215-9940
Practice Address - Street 1:2023 VALE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3834
Practice Address - Country:US
Practice Address - Phone:510-215-9930
Practice Address - Fax:510-215-9940
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC39042208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C390420Medicaid
CAA37046Medicare UPIN
CA00C390420Medicaid