MEDICARE: DR. EGILS KNUTS BOGDANOVICS 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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	031266	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4311140	OTHER	CT	AETNA CLAIMS
2	00131266003	OTHER	CT	BLUE CARE FAMILY PLAN
3	010031266CT05	OTHER	CT	BLUE CROSS BLUE SHIELD ID
4	3001	OTHER	CT	NEIC SITE ID, NSF BAO-7
5	2V1013	OTHER	CT	HEALTHNET ID
6	031266	OTHER	CT	CONNECTICARE ID
7	P2041176	OTHER	CT	OXFORD ID
8	031266	OTHER	CT	PROVIDER STATE LISCENCE #
9	0538237002	OTHER	CT	CIGNA HEALTH ID
10	4311104	OTHER	CT	AETNA EDI ID

General Provider Information

NPI Number	:	1619065976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EGILS KNUTS BOGDANOVICS M.D.

Provider Business Mailing Address
First Line	:	780 LITCHFIELD ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6268
Country	:	US
Telephone Number	:	860-496-2198
Fax Number	:	860-489-2482

Provider Business Practice Location Address
First Line	:	780 LITCHFIELD ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6268
Country	:	US
Telephone Number	:	860-496-2198
Fax Number	:	860-489-2482

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. EGILS KNUTS BOGDANOVICS M.D.” Practice Location

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