Provider Demographics
NPI:1255509873
Name:OGON, BERNARD OKEM (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:OKEM
Last Name:OGON
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 1:54 ANTHONY DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-5155
Mailing Address - Country:US
Mailing Address - Phone:773-983-2866
Mailing Address - Fax:
Practice Address - Street 1:1303 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2514
Practice Address - Country:US
Practice Address - Phone:215-458-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-16
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08756900207QG0300X
PAMD436175207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine