Provider Demographics
NPI:1033102538
Name:BOGDAN, CAROL ANN (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:BOGDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-1209
Mailing Address - Country:US
Mailing Address - Phone:843-652-8220
Mailing Address - Fax:843-527-7080
Practice Address - Street 1:2405 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-7764
Practice Address - Country:US
Practice Address - Phone:843-545-7274
Practice Address - Fax:843-545-8315
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27515207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC275152Medicaid
NC5900387Medicaid
SCH527182547Medicare PIN
SCH527186528Medicare PIN
H52718Medicare UPIN
SC275152Medicaid
SCH527186037Medicare PIN