Provider Demographics
NPI:1346237922
Name:BOGUE, LAUREN LAUCK (MD,FAAP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LAUCK
Last Name:BOGUE
Suffix:
Gender:F
Credentials:MD,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 FALLS ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4515
Mailing Address - Country:US
Mailing Address - Phone:410-583-2955
Mailing Address - Fax:410-583-2962
Practice Address - Street 1:10755 FALLS ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4515
Practice Address - Country:US
Practice Address - Phone:410-583-2955
Practice Address - Fax:410-583-2962
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE25314Medicare UPIN