Provider Demographics
NPI:1083162887
Name:MEJIA-BOGDANSKI, MARIA MERCEDES
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MERCEDES
Last Name:MEJIA-BOGDANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10226 BRADLEY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3929
Mailing Address - Country:US
Mailing Address - Phone:410-997-7022
Mailing Address - Fax:
Practice Address - Street 1:610 E DIAMOND AVE STE E
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-5332
Practice Address - Country:US
Practice Address - Phone:301-330-4359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29938390200000X
MD9611171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program