Healthcare Provider Details

I. General information

NPI: 1043289051
Provider Name (Legal Business Name): DAVID L BOGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LOWER WESTFIELD RD STE1
HOLYOKE MA
01040-2890
US

IV. Provider business mailing address

150 LOWER WESTFIELD RD STE1
HOLYOKE MA
01040
US

V. Phone/Fax

Practice location:
  • Phone: 413-536-2393
  • Fax: 413-536-1087
Mailing address:
  • Phone: 413-536-2393
  • Fax: 413-536-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57315
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: