Provider Demographics
NPI:1922796499
Name:BETHANY MEDICAL CARE
Entity Type:Organization
Organization Name:BETHANY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOGONKO
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHENCHI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:302-359-8795
Mailing Address - Street 1:11 FOX HALL
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2620
Mailing Address - Country:US
Mailing Address - Phone:302-359-8795
Mailing Address - Fax:
Practice Address - Street 1:11 FOX HALL
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2620
Practice Address - Country:US
Practice Address - Phone:302-359-8795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty