Provider Demographics
NPI:1053644179
Name:RYAN, ELIZABETH BOGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BOGEL
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:85 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1542
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:607-753-6677
Practice Address - Street 1:28601 CHAGRIN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4556
Practice Address - Country:US
Practice Address - Phone:888-288-4715
Practice Address - Fax:833-260-2594
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY272489207Q00000X, 207QA0401X
CODR.0070137207QA0401X
OH35.145681207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03802068Medicaid