Healthcare Provider Details

I. General information

NPI: 1093061772
Provider Name (Legal Business Name): MARIYA KOGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SAINT JOHNSBURY RD
LITTLETON NH
03561-3442
US

IV. Provider business mailing address

PO BOX 1598
CAMPTON NH
03223-1598
US

V. Phone/Fax

Practice location:
  • Phone: 603-444-9565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9281556
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4241
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number073409-23
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number505545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: