MEDICARE: MRS. GALINA BOGDANOVA MPA-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	0010-01951	NC

General Provider Information

NPI Number	:	1669621025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GALINA BOGDANOVA MPA-C

Provider Business Mailing Address
First Line	:	360 E CHARITY RD
Second Line	:
City	:	ROSE HILL
State	:	NC
Zip	:	28458-8303
Country	:	US
Telephone Number	:	910-289-3086
Fax Number	:	910-289-2413

Provider Business Practice Location Address
First Line	:	360 E CHARITY RD
Second Line	:
City	:	ROSE HILL
State	:	NC
Zip	:	28458-8303
Country	:	US
Telephone Number	:	910-289-3086
Fax Number	:	910-289-2413

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

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	04/05/2011

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