Provider Demographics
NPI:1255310249
Name:BOGGESS, DARRELL K (DO)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:K
Last Name:BOGGESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CURTIS PRICE WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1824
Mailing Address - Country:US
Mailing Address - Phone:304-926-2200
Mailing Address - Fax:304-926-2238
Practice Address - Street 1:1001 CURTIS PRICE WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1824
Practice Address - Country:US
Practice Address - Phone:304-926-2200
Practice Address - Fax:304-926-2238
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1567207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055315000Medicaid
001719575OtherBLUE CROSS BLUE SHIELD
5064588OtherAETNA
WV0055315000Medicaid
2030668Medicare PIN
2030665Medicare PIN
G76284Medicare UPIN
2030666Medicare PIN
2030663Medicare PIN
2030661Medicare PIN
2030662Medicare PIN
WVWV0963AMedicare PIN
2030664Medicare PIN