Provider Demographics
NPI:1710986906
Name:BOGDANSKI, CRAIG M (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:M
Last Name:BOGDANSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 WINDING RDG
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2180
Mailing Address - Country:US
Mailing Address - Phone:860-620-0801
Mailing Address - Fax:
Practice Address - Street 1:825 MERIDEN WATERBURY TPKE
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4156
Practice Address - Country:US
Practice Address - Phone:860-621-2673
Practice Address - Fax:860-621-2789
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039027207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001390278Medicaid
CT040039027CT02OtherBLUE CROSS/BLUE SHIELD
CTH33555Medicare UPIN
CT040039027CT02OtherBLUE CROSS/BLUE SHIELD