MEDICARE: MS. MARY K OGARA LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN094691L	PA

General Provider Information

NPI Number	:	1588802565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY K OGARA LPN

Provider Business Mailing Address
First Line	:	4240 CHIPPENDALE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3604
Country	:	US
Telephone Number	:	215-332-4176
Fax Number	:	215-332-4176

Provider Business Practice Location Address
First Line	:	4240 CHIPPENDALE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3604
Country	:	US
Telephone Number	:	215-332-4176
Fax Number	:	215-332-4176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2009
Last Update Date	:	01/28/2009

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