Healthcare Provider Details

I. General information

NPI: 1740740398
Provider Name (Legal Business Name): PAUL COOGAN MONTANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 VINEYARD WAY
WEST GROVE PA
19390-8835
US

IV. Provider business mailing address

1215 LEE ST BOX 800158
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-1929
  • Fax: 302-366-1075
Mailing address:
  • Phone: 434-243-1000
  • Fax: 434-244-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC1-0029343
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD494607
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0029343
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0106641
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0106641
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD494607
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: