MEDICARE: MRS. ASHLEY MARIE BOGUE PA-C

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
1	363AM0700X	Medical Physician Assistant	3387	CT

General Provider Information

NPI Number	:	1538543368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY MARIE BOGUE PA-C

Provider Business Mailing Address
First Line	:	3606 RIVER RD
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-5709
Country	:	US
Telephone Number	:	860-306-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 EAST ST
Second Line	:
City	:	PLAINVILLE
State	:	CT
Zip	:	06062-2913
Country	:	US
Telephone Number	:	860-747-5766
Fax Number	:	860-747-2028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	03/31/2020

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