Provider Demographics
NPI:1962413898
Name:KAHGAN, MARC P (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:P
Last Name:KAHGAN
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 1:201 PROSPECT AVE
Mailing Address - Street 2:CPEP
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1805
Mailing Address - Country:US
Mailing Address - Phone:315-448-6555
Mailing Address - Fax:315-423-6820
Practice Address - Street 1:201 PROSPECT AVE
Practice Address - Street 2:CPEP
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1805
Practice Address - Country:US
Practice Address - Phone:315-448-6555
Practice Address - Fax:315-423-6820
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240232-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B64285Medicare UPIN
RB1414Medicare PIN