1619065976 NPI number — DR. EGILS KNUTS BOGDANOVICS M.D.

Table of content: DR. EGILS KNUTS BOGDANOVICS M.D. (NPI 1619065976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619065976 NPI number — DR. EGILS KNUTS BOGDANOVICS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOGDANOVICS
Provider First Name:
EGILS
Provider Middle Name:
KNUTS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619065976
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 LITCHFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06790-6268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-496-2198
Provider Business Mailing Address Fax Number:
860-489-2482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 LITCHFIELD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06790-6268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-496-2198
Provider Business Practice Location Address Fax Number:
860-489-2482
Provider Enumeration Date:
10/11/2006

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: 207RE0101X , with the licence number:  031266 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4311140 . This is a "AETNA CLAIMS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 00131266003 . This is a "BLUE CARE FAMILY PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010031266CT05 . This is a "BLUE CROSS BLUE SHIELD ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3001 . This is a "NEIC SITE ID, NSF BAO-7" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V1013 . This is a "HEALTHNET ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 031266 . This is a "CONNECTICARE ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2041176 . This is a "OXFORD ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 031266 . This is a "PROVIDER STATE LISCENCE #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0538237002 . This is a "CIGNA HEALTH ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4311104 . This is a "AETNA EDI ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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