Healthcare Provider Details

I. General information

NPI: 1902892904
Provider Name (Legal Business Name): BOGDAN P GHEORGHIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2005
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 BOILING SPRINGS RD
SPARTANBURG SC
29303-2201
US

IV. Provider business mailing address

1071 BOILING SPRINGS RD
SPARTANBURG SC
29303-2201
US

V. Phone/Fax

Practice location:
  • Phone: 864-577-9107
  • Fax:
Mailing address:
  • Phone: 864-577-9107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19324
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number192745
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2006-00088
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: