Provider Demographics
NPI:1154632388
Name:PROTYNIAK, BOGDAN (MD, FACS, FASCRS)
Entity Type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:
Last Name:PROTYNIAK
Suffix:
Gender:M
Credentials:MD, FACS, FASCRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 EAST MOUNTAIN BLVD
Practice Address - Street 2:MC: 37-62
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711
Practice Address - Country:US
Practice Address - Phone:570-808-2340
Practice Address - Fax:570-808-7904
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457834208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery