Provider Demographics
NPI:1629356985
Name:HOGAN, MAUREEN COLLINS (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:COLLINS
Last Name:HOGAN
Suffix:
Gender:F
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:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3418
Mailing Address - Fax:415-883-8082
Practice Address - Street 1:3700 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1618
Practice Address - Country:US
Practice Address - Phone:415-600-2940
Practice Address - Fax:415-883-8082
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1178072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFH904YMedicare PIN
CAFH904TMedicare PIN
CAFH904VMedicare PIN
CAFH904WMedicare PIN
CAFH904XMedicare PIN
CAFH904PMedicare PIN
CAFH904QMedicare PIN
CAFH904RMedicare PIN
CAFH904SMedicare PIN
CAFH904ZMedicare PIN
CAFH904UMedicare PIN