Provider Demographics
NPI:1245305812
Name:COGAN, OSCAR (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:COGAN
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 1:4820 ALPENGLOW DR NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-8543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 WARREN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1487
Practice Address - Country:US
Practice Address - Phone:360-478-2366
Practice Address - Fax:360-373-2096
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D29158Medicare UPIN