Provider Demographics
NPI:1780690313
Name:KOGAN, MARK HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HAROLD
Last Name:KOGAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2089 VALE RD
Mailing Address - Street 2:SUITE 33
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3847
Mailing Address - Country:US
Mailing Address - Phone:510-234-5012
Mailing Address - Fax:510-234-4921
Practice Address - Street 1:2089 VALE RD
Practice Address - Street 2:SUITE 33
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3847
Practice Address - Country:US
Practice Address - Phone:510-234-5012
Practice Address - Fax:510-234-4921
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-09-25
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Provider Licenses
StateLicense IDTaxonomies
CAG60809207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G608092Medicare PIN