Healthcare Provider Details

I. General information

NPI: 1396682910
Provider Name (Legal Business Name): MICHAEL PATRICK HOGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CROSSWIND DR
FAIRMONT WV
26554-9118
US

IV. Provider business mailing address

1139 AVALON RD
FAIRMONT WV
26554-5027
US

V. Phone/Fax

Practice location:
  • Phone: 304-363-2228
  • Fax: 304-363-2288
Mailing address:
  • Phone: 304-363-2228
  • Fax: 304-363-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: