Healthcare Provider Details

I. General information

NPI: 1346480795
Provider Name (Legal Business Name): RICHARD BOHON B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 POST AVE.
NEW STANTON PA
15672-0638
US

IV. Provider business mailing address

PO BOX 638
NEW STANTON PA
15672-0638
US

V. Phone/Fax

Practice location:
  • Phone: 724-925-2680
  • Fax: 724-925-2520
Mailing address:
  • Phone: 724-925-2680
  • Fax: 724-925-2520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12474
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: