Provider Demographics
NPI:1336180363
Name:HOGAN, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
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:PO BOX 1645
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1645
Mailing Address - Country:US
Mailing Address - Phone:304-598-2291
Mailing Address - Fax:304-598-2293
Practice Address - Street 1:99 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-4000
Practice Address - Country:US
Practice Address - Phone:304-598-2291
Practice Address - Fax:304-598-2293
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV099502085R0202X
NY1018292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1071180OtherWEST VIRGINIA WORKERS COM
WV000000403OtherBLUE CROSS BLUE SHIELD
WVP00401419OtherRAILROAD MEDICARE
WV0119977000Medicaid
WV000000403OtherBLUE CROSS BLUE SHIELD
A72020Medicare UPIN