Basic Information
| Provider Information | |||||||||
| NPI: | 1770599516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOGAN | ||||||||
| FirstName: | CLIFFORD | ||||||||
| MiddleName: | RAYMOND | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 882 E BRADY RD | ||||||||
| Address2: | COWANSVILLE AREA HEALTH CENTER | ||||||||
| City: | COWANSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162181316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245485605 | ||||||||
| FaxNumber: | 7245437425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 NOLTE DR | ||||||||
| Address2: | ARMSTRONG COUNTY MEMORIAL HOSPITAL | ||||||||
| City: | KITTANNING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162017111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245438109 | ||||||||
| FaxNumber: | 7245438809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 08/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD021896E | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD021896E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0006962650006 | 05 | PA | MEDICAID |