Provider Demographics
NPI:1740438423
Name:BOGUCKI, BENJAMIN A (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:A
Last Name:BOGUCKI
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 1:150 TAYLOR STATION RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4440
Mailing Address - Country:US
Mailing Address - Phone:614-863-3222
Mailing Address - Fax:
Practice Address - Street 1:150 TAYLOR STATION RD
Practice Address - Street 2:SUITE 250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4440
Practice Address - Country:US
Practice Address - Phone:614-863-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009009411207N00000X
OH35121262207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology