Provider Demographics
NPI:1396977484
Name:OGANOVICH, MICHAEL MORGAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MORGAN
Last Name:OGANOVICH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAMEDDAC FORT MEADE
Mailing Address - Street 2:2480 LLEWELLYN ROAD
Mailing Address - City:FORT GEORGE G. MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755
Mailing Address - Country:US
Mailing Address - Phone:773-627-3207
Mailing Address - Fax:
Practice Address - Street 1:160TH THEATER SIGNAL BRIGADE
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09366
Practice Address - Country:US
Practice Address - Phone:733-457-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-22
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60210307103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical