Provider Demographics
NPI:1194884593
Name:KOGAN, EVAN S (PHD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:S
Last Name:KOGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 CLAIRTON BLVD STE 500-600
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-5505
Mailing Address - Country:US
Mailing Address - Phone:412-650-1100
Mailing Address - Fax:412-650-1101
Practice Address - Street 1:810 CLAIRTON BLVD STE 500-600
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-5505
Practice Address - Country:US
Practice Address - Phone:412-650-1100
Practice Address - Fax:412-650-1101
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical