Provider Demographics
NPI:1205046992
Name:HOGAN, JEREMY P (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:P
Last Name:HOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S MAIN ST STE H
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4411
Mailing Address - Country:US
Mailing Address - Phone:603-569-7690
Mailing Address - Fax:603-569-7664
Practice Address - Street 1:240 S MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4411
Practice Address - Country:US
Practice Address - Phone:603-569-7690
Practice Address - Fax:603-569-7664
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14840207X00000X
MI4301083570207XP3100X
FLME103929207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000886300Medicaid
FL9070299OtherAENTA
FL30366OtherBCBS
FL4131100OtherCIGNA
FL9070299OtherAENTA
FL328122OtherAVMED
FL000886300Medicaid