Provider Demographics
NPI:1225440324
Name:BOGNER, RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BOGNER
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 1:2857 CHARLESTOWN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-1998
Mailing Address - Country:US
Mailing Address - Phone:812-944-7500
Mailing Address - Fax:812-944-6424
Practice Address - Street 1:2857 CHARLESTOWN RD STE 100
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-1998
Practice Address - Country:US
Practice Address - Phone:812-944-7500
Practice Address - Fax:812-944-6424
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51443207N00000X
ND15560207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100374070Medicaid