Healthcare Provider Details

I. General information

NPI: 1275257537
Provider Name (Legal Business Name): JESSE DOGAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

5 WINDSOR DR
ROYERSFORD PA
19468-4315
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-8416
  • Fax:
Mailing address:
  • Phone: 215-668-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number624118
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: