Basic Information
| Provider Information | |||||||||
| NPI: | 1700870433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOGAN | ||||||||
| FirstName: | INNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 WATER ST APT 736 | ||||||||
| Address2: | |||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019155080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035057702 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 SW JEWELL AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852955310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 010124995 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 11706 | NH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | 78039 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 390200000X | 0116023802 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RP1001X | MD16070 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 30203222 | 05 | NH | MEDICAID |