Provider Demographics
NPI:1700834793
Name:COGAN, RICHARD (MS, CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:COGAN
Suffix:
Gender:M
Credentials:MS, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 CORNUS CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-4628
Mailing Address - Country:US
Mailing Address - Phone:856-881-3475
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136
Practice Address - Country:US
Practice Address - Phone:215-335-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25N010377900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered