Provider Demographics
NPI:1962572172
Name:HOGAN, MARY JANE S (MD, MPH)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:S
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:LMP 2073
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-785-4640
Mailing Address - Fax:203-737-2228
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:LMP 2073
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:203-785-4640
Practice Address - Fax:203-737-2228
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0374222080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001374222Medicaid
CT370001467Medicare ID - Type Unspecified
H73418Medicare UPIN