Provider Demographics
NPI:1811086515
Name:KOGON, BRIAN E (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:KOGON
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 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-502-2037
Practice Address - Fax:410-955-0737
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24762208G00000X
VA0101279530208G00000X
GA053322208G00000X
FLME150500208G00000X
PAMD424488208G00000X
MDD0101861208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA358568367AMedicaid
MS06121562Medicaid
GA358568367AMedicaid
MS555412YJ5DMedicare PIN
GAI1761001Medicare UPIN