Provider Demographics
NPI:1154371896
Name:HOGANS, BETH BRIANNA (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:BRIANNA
Last Name:HOGANS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WEST RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2308
Mailing Address - Country:US
Mailing Address - Phone:410-823-3600
Mailing Address - Fax:
Practice Address - Street 1:22 WEST RD STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-2308
Practice Address - Country:US
Practice Address - Phone:410-823-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD540402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400674700Medicaid
MDKR37JHMedicare ID - Type UnspecifiedGROUP
MDE193Medicare ID - Type UnspecifiedINDIVIDUAL
MDH67939Medicare UPIN