Provider Demographics
NPI:1659551364
Name:BOGDAN, ANN C (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:C
Last Name:BOGDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:C
Other - Last Name:PEDERZOLLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2600 SIXTH ST SW
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-1702
Mailing Address - Country:US
Mailing Address - Phone:330-363-6200
Mailing Address - Fax:330-363-6008
Practice Address - Street 1:2600 SIXTH ST SW
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-6200
Practice Address - Fax:330-363-6008
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0983592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology