MEDICARE: ALAN OTTO KOGAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	4301028081	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659437671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN OTTO KOGAN M.D.

Provider Business Mailing Address
First Line	:	610 E DIAMOND AVE
Second Line	:	SUITE 100A
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-5321
Country	:	US
Telephone Number	:	301-840-3200
Fax Number	:	301-840-1348

Provider Business Practice Location Address
First Line	:	610 E DIAMOND AVE
Second Line	:	SUITE 100A
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-5321
Country	:	US
Telephone Number	:	301-840-3200
Fax Number	:	301-840-1348

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	05/22/2012

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