Provider Demographics
NPI:1841235462
Name:BOGNER, HILLARY R (MD)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:R
Last Name:BOGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51 N 39TH STREET
Mailing Address - Street 2:7 FLOOR - MUTCH BLDG
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-8777
Mailing Address - Fax:215-243-3290
Practice Address - Street 1:51 N 39TH STREET
Practice Address - Street 2:7TH FLOOR- MUTCH BLDG.
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-8777
Practice Address - Fax:215-243-3290
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD065974L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00175305200001Medicaid
G93615Medicare UPIN
PA00175305200001Medicaid