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NPI Code Detail

MEDICARE: KATELYN BOGER

MEDICARE: KATELYN BOGER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1740058775
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN BOGER
Provider Business Mailing Address
First Line : 3241 WESTERN BRANCH BLVD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-5260
Country : US
Telephone Number : 757-967-8622
Fax Number :
Provider Business Practice Location Address
First Line : 3241 WESTERN BRANCH BLVD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-5260
Country : US
Telephone Number : 757-967-8622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2023
Last Update Date : 01/06/2026

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Directions to “ KATELYN BOGER ” Practice Location

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