Provider Demographics
NPI:1255138137
Name:COOGAN, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:COOGAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 VIRGINIA AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1918
Mailing Address - Country:US
Mailing Address - Phone:202-994-7644
Mailing Address - Fax:
Practice Address - Street 1:2600 VIRGINIA AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1918
Practice Address - Country:US
Practice Address - Phone:202-994-7644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program