1659551364 NPI number — ANN C BOGDAN MD

Table of content: ANN C BOGDAN MD (NPI 1659551364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659551364 NPI number — ANN C BOGDAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOGDAN
Provider First Name:
ANN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEDERZOLLI
Provider Other First Name:
ANN
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659551364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 SIXTH ST SW
Provider Second Line Business Mailing Address:
RADIOLOGY ASSOCIATES OF CANTON
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44710-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-363-6200
Provider Business Mailing Address Fax Number:
330-363-6008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 SIXTH ST SW
Provider Second Line Business Practice Location Address:
RADIOLOGY ASSOCIATES OF CANTON
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44710-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-363-6200
Provider Business Practice Location Address Fax Number:
330-363-6008
Provider Enumeration Date:
11/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  098359 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)