Provider Demographics
NPI:1548208531
Name:BOGHDADY, MAGED (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGED
Middle Name:
Last Name:BOGHDADY
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 1:703 MAIN ST
Mailing Address - Street 2:OB/GYN DEPARTMNET
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2621
Mailing Address - Country:US
Mailing Address - Phone:973-754-4200
Mailing Address - Fax:973-754-2725
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:OB/GYN DEPARTMNET
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-4200
Practice Address - Fax:973-754-2725
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05746200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33887Medicare UPIN