MEDICARE: SUSAN BOGRAD

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	2084F0202X	Forensic Psychiatry Physician	34363	CO
2	2084P0800X	Psychiatry Physician	34363	CO

General Provider Information

NPI Number	:	1902236417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN BOGRAD

Provider Business Mailing Address
First Line	:	3300 E. 1ST AVENUE
Second Line	:	SUITE 590
City	:	DENVER
State	:	CO
Zip	:	80206-5818
Country	:	US
Telephone Number	:	303-320-1968
Fax Number	:	303-322-2155

Provider Business Practice Location Address
First Line	:	3300 E. 1ST AVENUE
Second Line	:	SUITE 590
City	:	DENVER
State	:	CO
Zip	:	80206-5818
Country	:	US
Telephone Number	:	303-320-1968
Fax Number	:	303-322-2155

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUSAN BOGRAD
Credential	:	M.D.
Telephone Number	:	303-320-1968

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	11/19/2013

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Directions to “SUSAN BOGRAD ” Practice Location

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