Provider Demographics
NPI:1619065976
Name:BOGDANOVICS, EGILS KNUTS (MD)
Entity Type:Individual
Prefix:DR
First Name:EGILS
Middle Name:KNUTS
Last Name:BOGDANOVICS
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 1:780 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6268
Mailing Address - Country:US
Mailing Address - Phone:860-496-2198
Mailing Address - Fax:860-489-2482
Practice Address - Street 1:780 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6268
Practice Address - Country:US
Practice Address - Phone:860-496-2198
Practice Address - Fax:860-489-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031266207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4311140OtherAETNA CLAIMS
CT00131266003OtherBLUE CARE FAMILY PLAN
CT010031266CT05OtherBLUE CROSS BLUE SHIELD ID
CT3001OtherNEIC SITE ID, NSF BAO-7
CT2V1013OtherHEALTHNET ID
CT031266OtherCONNECTICARE ID
CTP2041176OtherOXFORD ID
CT031266OtherPROVIDER STATE LISCENCE #
CT0538237002OtherCIGNA HEALTH ID
CT4311104OtherAETNA EDI ID
CT4311104OtherAETNA EDI ID
CT031266OtherCONNECTICARE ID