Healthcare Provider Details

I. General information

NPI: 1558936237
Provider Name (Legal Business Name): MATTHEW CHARLES HOGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WELLS ST # 2020
WESTERLY RI
02891-2961
US

IV. Provider business mailing address

45 WELLS ST STE 2020
WESTERLY RI
02891-2961
US

V. Phone/Fax

Practice location:
  • Phone: 401-596-2020
  • Fax: 401-596-6896
Mailing address:
  • Phone: 401-596-2020
  • Fax: 401-444-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLP05353
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD20282
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: