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NPI Code Detail

MEDICARE: DR. RYAN BOGNER M.D.

MEDICARE: DR. RYAN BOGNER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician51443KY
2207N00000XDermatology Physician15560ND

General Provider Information

NPI Number : 1225440324
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN BOGNER M.D.
Provider Business Mailing Address
First Line : 2857 CHARLESTOWN RD STE 100
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-1998
Country : US
Telephone Number : 812-944-7500
Fax Number : 812-944-6424
Provider Business Practice Location Address
First Line : 2857 CHARLESTOWN RD STE 100
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-1998
Country : US
Telephone Number : 812-944-7500
Fax Number : 812-944-6424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2014
Last Update Date : 05/15/2023

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