Provider Demographics
NPI:1437590627
Name:BOGDAN GOGIOIU MD PA
Entity Type:Organization
Organization Name:BOGDAN GOGIOIU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOGDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGIOIU
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:352-728-5466
Mailing Address - Street 1:1032 SHORE ACRES DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4506
Mailing Address - Country:US
Mailing Address - Phone:352-728-5466
Mailing Address - Fax:352-728-5466
Practice Address - Street 1:600 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-728-5466
Practice Address - Fax:352-728-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty