Provider Demographics
NPI:1902903123
Name:HOGAN, LORI REED (PAC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:REED
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 EASY ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3128
Mailing Address - Country:US
Mailing Address - Phone:724-438-1300
Mailing Address - Fax:724-438-1400
Practice Address - Street 1:205 EASY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3128
Practice Address - Country:US
Practice Address - Phone:724-438-1300
Practice Address - Fax:724-438-1400
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000616L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
064645Medicare ID - Type Unspecified
S51498Medicare UPIN