Provider Demographics
NPI:1366499410
Name:BOGNET MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BOGNET MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:BOGNET
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-821-2820
Mailing Address - Street 1:1275 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6207
Mailing Address - Country:US
Mailing Address - Phone:610-821-2820
Mailing Address - Fax:610-821-2859
Practice Address - Street 1:1275 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6207
Practice Address - Country:US
Practice Address - Phone:610-821-2820
Practice Address - Fax:610-821-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 009228L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0487888OtherHIGHMARK BLUE SHIELD
PA02699100OtherCAPITAL BLUE CROSS
PA021949Medicare ID - Type Unspecified