Provider Demographics
NPI:1578640207
Name:KOGAN, MICHAEL TODD (CP, BOCO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TODD
Last Name:KOGAN
Suffix:
Gender:M
Credentials:CP, BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 BITTERSWEET CIR
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1547 BITTERSWEET CIR
Practice Address - Street 2:
Practice Address - City:JAMISON
Practice Address - State:PA
Practice Address - Zip Code:18929-1429
Practice Address - Country:US
Practice Address - Phone:267-614-1538
Practice Address - Fax:267-897-9055
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0002035000OtherAMERIHEALTH HEALTH PLANS
PA0002035000OtherAMERIHEALTH HMO, INC
PA0002035000OtherPERSONAL CHOICE 65
PA0002035000OtherKEYSTONE HEALTHPLAN EAST
PA2035OtherTRADITIONAL INDEMNITY
PA2035OtherBLUE CHOICE
PA3753541OtherAETNA
PA0002035000OtherKEYSTONE POS
PA1012223920001Medicaid
PA0002035000OtherPERSONAL CHOICE
PA2035OtherAMERIHEALTH INSURANCE CO
PA0002035000OtherKEYSTONE 65
PA0002035000OtherPERSONAL CHOICE 65