Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0201X | Pediatric Allergist | 12265 | NV |
Y | 2080P0201X | Pediatric Allergist | 18282 | WV |
NPI | 1174603104 |
---|---|
Provider Name | Dr. Mary Beth Hogan |
First Address | Las Vegas, NV 89106-4195 |
Second Address | Huntington, WV 25701-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0109785000 | (05) | WV |
F79264 | (02) |