MEDICARE: SARAH ROSE BOGART PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1568192003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ROSE BOGART PA

Provider Business Mailing Address
First Line	:	187 MILLWOOD DR
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-5563
Country	:	US
Telephone Number	:	716-445-9454
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 NIAGARA FALLS BLVD
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14228-1639
Country	:	US
Telephone Number	:	716-799-1002
Fax Number	:

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

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	04/08/2026

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