Provider Demographics
NPI:1396708632
Name:HOGAN, ROBERT P (DO PC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:HOGAN
Suffix:
Gender:M
Credentials:DO PC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1230 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628
Mailing Address - Country:US
Mailing Address - Phone:609-883-5454
Mailing Address - Fax:609-883-2565
Practice Address - Street 1:1230 PARKWAY AVE STE 203
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3018
Practice Address - Country:US
Practice Address - Phone:609-883-5454
Practice Address - Fax:609-882-2565
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB51299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093802Medicare PIN
NJE55088Medicare UPIN