Provider Demographics
NPI:1457325227
Name:MOGERMAN, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:MOGERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-2574
Mailing Address - Country:US
Mailing Address - Phone:570-282-2724
Mailing Address - Fax:570-282-7132
Practice Address - Street 1:27A WOODLANDS DR
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472-9366
Practice Address - Country:US
Practice Address - Phone:570-488-9880
Practice Address - Fax:570-488-9882
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026871E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1343003OtherBLUE SHIELD
PA000860503Medicaid
B34445Medicare ID - Type Unspecified