Provider Demographics
NPI:1417484692
Name:BOGDAN, SAMANTHA JO (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JO
Last Name:BOGDAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 PARK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1573
Mailing Address - Country:US
Mailing Address - Phone:155-367-9982
Mailing Address - Fax:215-538-6459
Practice Address - Street 1:1021 PARK AVE
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-0130
Practice Address - Country:US
Practice Address - Phone:215-538-4690
Practice Address - Fax:866-410-3429
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021108207Q00000X, 207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program