Provider Demographics
NPI:1518062439
Name:MOLDOVEANU, BOGDAN (MD)
Entity Type:Individual
Prefix:
First Name:BOGDAN
Middle Name:
Last Name:MOLDOVEANU
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 1:501 E BROADWAY
Mailing Address - Street 2:#220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-589-4856
Mailing Address - Fax:502-589-5093
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1190
Practice Address - Country:US
Practice Address - Phone:502-368-9561
Practice Address - Fax:502-368-9616
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38256207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200853080Medicaid
KY7100010180Medicaid
INM1627870001Medicare PIN
KY7100010180Medicaid
KYK046601Medicare PIN