Provider Demographics
NPI:1639267107
Name:VATRA, BOGDAN CALIN (MD)
Entity Type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:CALIN
Last Name:VATRA
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 1:6 EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1257
Mailing Address - Country:US
Mailing Address - Phone:607-756-9470
Mailing Address - Fax:
Practice Address - Street 1:6 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1257
Practice Address - Country:US
Practice Address - Phone:607-756-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241854207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02825107Medicaid
NYJ300000184Medicare PIN
NYI66106Medicare UPIN