Healthcare Provider Details

I. General information

NPI: 1093770927
Provider Name (Legal Business Name): THOMAS B BOGNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 YOUNGS RD SUITE 104
WILLIAMSVILLE NY
14221-8053
US

IV. Provider business mailing address

3950 E ROBINSON RD SUITE 207
WEST AMHERST NY
14228-2041
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-7979
  • Fax: 716-636-7993
Mailing address:
  • Phone: 716-564-1111
  • Fax: 716-564-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number192000
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: