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General NPI Number Information
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NPI Number | 1942797378
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Entity Type | Organization
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Legal Business Name | SHARON A BOGERTY MD INC
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 105 N BASCOM AVE STE 101B
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City | SAN JOSE
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State | CA
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Zip | 95128-1811
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Country | US
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Telephone | 408-971-4997
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Fax | 408-971-4998
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Provider Business Mailing Address
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Address Line | 105 N BASCOM AVE STE 101B
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City | SAN JOSE
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State | CA
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Zip | 95128-1811
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Country | US
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Telephone | 408-971-4997
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHARON A BOGERTY
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Credential | MD
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Telephone | 408-971-4994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | G27618
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License Number State | CA
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