Provider Demographics
NPI:1598738551
Name:BOGEN, STEVE A (MD, PHD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:A
Last Name:BOGEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CHERYL DR
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1118
Mailing Address - Country:US
Mailing Address - Phone:617-636-5422
Mailing Address - Fax:617-636-8302
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:BOX 115
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-1112
Practice Address - Fax:617-636-1115
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58406207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3089541Medicaid
MA3089541Medicaid
MAF19974Medicare UPIN