Healthcare Provider Details

I. General information

NPI: 1164835724
Provider Name (Legal Business Name): NATHAN ALLEN BOGGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4954 NORTH PALMER ROAD BUILDING 19, ROOM 4112
BETHESDA MD
20889-5630
US

IV. Provider business mailing address

4954 NORTH PALMER ROAD BUILDING 19, ROOM 4112
BETHESDA MD
20889-5630
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-7988
  • Fax: 301-319-8299
Mailing address:
  • Phone: 301-295-7988
  • Fax: 301-319-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD045081
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD045081
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: