Provider Demographics
NPI:1093770927
Name:BOGNER, THOMAS B (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:BOGNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3950 E ROBINSON RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2041
Mailing Address - Country:US
Mailing Address - Phone:716-564-1111
Mailing Address - Fax:716-564-1128
Practice Address - Street 1:1150 YOUNGS RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8053
Practice Address - Country:US
Practice Address - Phone:716-636-7979
Practice Address - Fax:716-636-7993
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2010-07-13
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Provider Licenses
StateLicense IDTaxonomies
NY192000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01412371Medicaid
NYF65825Medicare UPIN
NY01412371Medicaid