Provider Demographics
NPI:1932646577
Name:HOGAN, MARK P (ATC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:HOGAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 DELAMAR AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5122
Mailing Address - Country:US
Mailing Address - Phone:505-377-6808
Mailing Address - Fax:
Practice Address - Street 1:806 DELAMAR AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5122
Practice Address - Country:US
Practice Address - Phone:505-377-6808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor