Healthcare Provider Details

I. General information

NPI: 1396977484
Provider Name (Legal Business Name): MICHAEL MORGAN OGANOVICH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2009
Last Update Date: 08/08/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160TH THEATER SIGNAL BRIGADE
APO AE
09366
US

IV. Provider business mailing address

USAMEDDAC FORT MEADE 2480 LLEWELLYN ROAD
FORT GEORGE G. MEADE MD
20755
US

V. Phone/Fax

Practice location:
  • Phone: 733-457-7826
  • Fax:
Mailing address:
  • Phone: 773-627-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60210307
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: