Provider Demographics
NPI:1912972811
Name:COGBURN, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:COGBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:78 LONG SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704
Mailing Address - Country:US
Mailing Address - Phone:828-684-0703
Mailing Address - Fax:828-684-5344
Practice Address - Street 1:78 LONG SHOALS RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-7782
Practice Address - Country:US
Practice Address - Phone:828-684-0703
Practice Address - Fax:828-684-5344
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29542207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7923470Medicaid
NC7923470Medicaid
NCC87614Medicare UPIN