Provider Demographics
NPI:1578531984
Name:BOGUSKY, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BOGUSKY
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 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-973-5918
Practice Address - Fax:508-973-5916
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36266207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRB56857Medicaid
MA110047988AMedicaid
MA110047988AMedicaid
MA036266OtherTUFTS HEALTH PLAN
RICP00202605OtherBCBSRIBLUECHIP
MA1982607537OtherTRICARE
MA0000495OtherNEIGHBORHOOD HEALTH PLAN
MA042675800OtherUNITED HEALTH
MA6868OtherHARVARD PILGRIM
MA96025201OtherNETWORK HEALTH
RIRB56857Medicaid
MA000000036965OtherBMC HEALTHNET
MD466569OtherAETNA
MA110047988AMedicaid
MAC0505902Medicare PIN