Individual provider Active NPI

Mark Litton Cogburn, MD

  • Urology Physician
  • New York, NY
National Provider Identifier
1164788691
Registry record updated Jun 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
330437 Issued in NY
Practice address
161 Fort Washington Ave FL 11
New York, NY 10032-3729
Phone
(212) 305-0114
Fax
(212) 305-0116
NPI assigned
Apr 10, 2012
Last updated
Jun 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 56158 AZ
Urology Physician 208800000X 330437 NY Primary

Addresses

Primary practice location

161 Fort Washington Ave FL 11
New York, NY 10032-3729

Mailing address

161 Fort Washington Ave FL 11
New York, NY 10032-3729
Phone (212) 305-0114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240709002546 NY Practitioner - Urology 1456686096 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
56158AZMDUrology Physician
330437NYMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York Urology Current Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jun 13, 2024 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Jun 13, 2024 Accepting new patients
The Trustees of Columbia University in the City of New York Urology PastSince Jun 30, 2024 Accepting new patients

Locations

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

161 Fort Washington Ave
Fl 11
New York, NY 10032
Phone (212) 305-1371

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: mcogburn272631@ahs.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1164788691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 FORT WASHINGTON AVE FL 11",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323729",
            "telephone_number": "212-305-0114",
            "fax_number": "212-305-0116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 FORT WASHINGTON AVE FL 11",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323729",
            "telephone_number": "212-305-0114",
            "fax_number": "212-305-0116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COGBURN",
        "first_name": "MARK",
        "middle_name": "LITTON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-10",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "AZ",
            "license": "56158",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "330437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.