Provider Demographics
NPI:1093130197
Name:BOGDASARIAN, HALEY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:MARIE
Last Name:BOGDASARIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:MARIE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 MAIN ST
Mailing Address - Street 2:PO BOX 658
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1247
Mailing Address - Country:US
Mailing Address - Phone:978-827-5167
Mailing Address - Fax:
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHBURNHAM
Practice Address - State:MA
Practice Address - Zip Code:01430-1247
Practice Address - Country:US
Practice Address - Phone:978-827-5167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant