Provider Demographics
NPI:1073659819
Name:RONALD T. BOGUSKY, M.D., P.C.
Entity Type:Organization
Organization Name:RONALD T. BOGUSKY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOGUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-990-8837
Mailing Address - Street 1:307 ROCK ODUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-1443
Mailing Address - Country:US
Mailing Address - Phone:508-990-8837
Mailing Address - Fax:
Practice Address - Street 1:307 ROCK ODUNDEE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-1443
Practice Address - Country:US
Practice Address - Phone:508-990-8837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3058492Medicaid
MAB76512Medicare UPIN
MA3058492Medicaid