Provider Demographics
NPI:1821316654
Name:HOGAN, LISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10940 RAVEN RIDGE RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6610
Mailing Address - Country:US
Mailing Address - Phone:919-847-1495
Mailing Address - Fax:919-847-1549
Practice Address - Street 1:10940 RAVEN RIDGE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6610
Practice Address - Country:US
Practice Address - Phone:919-847-1495
Practice Address - Fax:919-847-1549
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2007-00584207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology