Healthcare Provider Details

I. General information

NPI: 1962572172
Provider Name (Legal Business Name): MARY JANE S HOGAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST LMP 2073
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

333 CEDAR ST LMP 2073
NEW HAVEN CT
06510-3206
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4640
  • Fax: 203-737-2228
Mailing address:
  • Phone: 203-785-4640
  • Fax: 203-737-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number037422
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: