Provider Demographics
NPI:1558466755
Name:HOGAN, NICHOLAS JAMES (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:HOGAN
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44045 RIVERSIDE PKWY
Mailing Address - Street 2:INOVA HOSPITAL CENTER - EMERG DEPT
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-5101
Mailing Address - Country:US
Mailing Address - Phone:703-858-6044
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:44045 RIVERSIDE PKWY
Practice Address - Street 2:INOVA HOSPITAL CENTER - EMERG DEPT
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5101
Practice Address - Country:US
Practice Address - Phone:703-858-6044
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101240283207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011956C77Medicare PIN