Healthcare Provider Details

I. General information

NPI: 1427544840
Provider Name (Legal Business Name): PRACHI ASHOK BHOGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

IV. Provider business mailing address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-9104
  • Fax: 814-534-3559
Mailing address:
  • Phone: 814-534-9104
  • Fax: 814-534-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT216326
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT216326
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: