Provider Demographics
NPI:1245358175
Name:KOGAN, MIA (MD)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 I ST NW
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2206
Mailing Address - Country:US
Mailing Address - Phone:202-463-8900
Mailing Address - Fax:202-785-9811
Practice Address - Street 1:2405 I ST NW
Practice Address - Street 2:SUITE 2A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2206
Practice Address - Country:US
Practice Address - Phone:202-463-8900
Practice Address - Fax:202-785-9811
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD32471174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist