Provider Demographics
NPI:1760485460
Name:HOGAN, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:HOGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:6 HEARTS WAY
Practice Address - Street 2:ADIRONDACK CARDIOLOGY
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5925
Practice Address - Country:US
Practice Address - Phone:518-792-1233
Practice Address - Fax:518-792-6854
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-06-08
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Provider Licenses
StateLicense IDTaxonomies
NY202931207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02161888Medicaid
NYJ400061520Medicare PIN
NY02161888Medicaid