Provider Demographics
NPI:1689619033
Name:HOGAN, NATALIE MENENDEZ (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MENENDEZ
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 1:4700 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-8180
Mailing Address - Fax:912-350-7221
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-8180
Practice Address - Fax:912-350-7221
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042283208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA349784OtherWELLCARE
GA000768512AMedicaid
GA10065689OtherAMERIGROUP
GA370017875OtherRR MEDICARE
SCG42283Medicaid
GA37BBFTHMedicare PIN
GA000768512AMedicaid