Provider Demographics
NPI:1700954336
Name:NOGHNOGH, ABD (MD)
Entity Type:Individual
Prefix:DR
First Name:ABD
Middle Name:
Last Name:NOGHNOGH
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 583
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46325-0583
Mailing Address - Country:US
Mailing Address - Phone:219-836-5160
Mailing Address - Fax:219-836-5170
Practice Address - Street 1:8230 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1753
Practice Address - Country:US
Practice Address - Phone:219-836-5160
Practice Address - Fax:219-836-5170
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045772207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200135890CMedicaid
IN200135890CMedicaid
IL211453Medicare PIN
IN220430AMedicare PIN