Healthcare Provider Details

I. General information

NPI: 1033521653
Provider Name (Legal Business Name): ROBERT BOGLI D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 SMITH RD STE 100A
CINCINNATI OH
45212-2796
US

IV. Provider business mailing address

501 MADISON AVE
SCRANTON PA
18510-2401
US

V. Phone/Fax

Practice location:
  • Phone: 513-841-0777
  • Fax: 513-841-0877
Mailing address:
  • Phone: 570-343-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34012559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: