Provider Demographics
NPI:1609952001
Name:BOGLER, WILLIAM ALOYSIUS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALOYSIUS
Last Name:BOGLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9315
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-522-4120
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:SUITE 318
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9362
Practice Address - Country:US
Practice Address - Phone:570-522-5033
Practice Address - Fax:570-522-4480
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232809429018OtherTRICARE
PA232809429018OtherTRICARE