Provider Demographics
NPI:1689724239
Name:BOGER, ERIN ANNE
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:ANNE
Last Name:BOGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STATION ST
Mailing Address - Street 2:APT C
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2759
Mailing Address - Country:US
Mailing Address - Phone:740-590-4909
Mailing Address - Fax:
Practice Address - Street 1:215 COLUMBUS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1335
Practice Address - Country:US
Practice Address - Phone:740-592-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist