MEDICARE: BOGDAN BAKALOV MD

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
1	207V00000X	Obstetrics & Gynecology Physician	153329	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811104581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOGDAN BAKALOV MD

Provider Business Mailing Address
First Line	:	2113 E 38TH
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4929
Country	:	US
Telephone Number	:	718-377-2838
Fax Number	:	718-377-5952

Provider Business Practice Location Address
First Line	:	92-11 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7857
Country	:	US
Telephone Number	:	718-651-0300
Fax Number	:	718-639-5513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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