Provider Demographics
NPI:1205036472
Name:BOGDAN, ALLAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:J
Last Name:BOGDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4004
Mailing Address - Country:US
Mailing Address - Phone:207-596-6467
Mailing Address - Fax:
Practice Address - Street 1:34 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4004
Practice Address - Country:US
Practice Address - Phone:207-596-6467
Practice Address - Fax:207-596-6452
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21363207W00000X
NJ25MA08680600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102948257Medicaid
PABO361191Medicare PIN