Provider Demographics
NPI:1972860427
Name:HOGAN, ELISE C (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:C
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E WOODLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3969
Mailing Address - Country:US
Mailing Address - Phone:215-779-3222
Mailing Address - Fax:
Practice Address - Street 1:1401 FOULK RD STE 100B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2764
Practice Address - Country:US
Practice Address - Phone:302-477-3300
Practice Address - Fax:302-477-3168
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454480207Q00000X
DEC1-0013198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine