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General NPI Number Information
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NPI Number | 1740438423
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Entity Type | Individual
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Provider Name | BENJAMIN A BOGUCKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 150 TAYLOR STATION RD SUITE 250
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City | COLUMBUS
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State | OH
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Zip | 43213-4440
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Country | US
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Telephone | 614-863-3222
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Fax |
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Provider Business Mailing Address
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Address Line | 150 TAYLOR STATION RD SUITE 250
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City | COLUMBUS
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State | OH
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Zip | 43213-4440
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Country | US
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Telephone | 614-863-3222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2009009411
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35121262
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License Number State | OH
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