Healthcare Provider Details

I. General information

NPI: 1609360684
Provider Name (Legal Business Name): ANDREW HOGROGIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E EVESHAM RD STE 100B
VOORHEES NJ
08043-1437
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-7118
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax: 215-662-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD477728
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA11939300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: