Basic Information
Provider Information
NPI: 1003000159
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOGES
FirstName: MARSHA
MiddleName: SUSAN
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4115 DORCHESTER ROAD
Address2: CONCENTRA
City: CHARLESTON
State: SC
PostalCode: 29405
CountryCode: US
TelephoneNumber: 8435546737
FaxNumber: 8435543356
Practice Location
Address1: 4115 DORCHESTER ROAD
Address2: CONCENTRA MEDICAL CENTER
City: CHARLESTON
State: SC
PostalCode: 29405
CountryCode: US
TelephoneNumber: 8435546737
FaxNumber: 8435543356
Other Information
ProviderEnumerationDate: 08/31/2007
LastUpdateDate: 10/29/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X810SCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
NP040405SC MEDICAID
P09926929501SCMEDICARE PTANOTHER


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