Provider Demographics
NPI:1154414837
Name:HOGAN, TIMOTHY HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:HARVEY
Last Name:HOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 NORTH FIRST ST.
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45873
Mailing Address - Country:US
Mailing Address - Phone:419-594-3520
Mailing Address - Fax:419-594-3530
Practice Address - Street 1:109 NORTH FIRST ST.
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45873
Practice Address - Country:US
Practice Address - Phone:419-594-3520
Practice Address - Fax:419-594-3530
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407025570OtherGROUP NPI#
9299272OtherMEDICARE GROUP #
1407025570OtherGROUP NPI#