Provider Demographics
NPI:1023790649
Name:BOGLE, TEJA
Entity type:Individual
Prefix:
First Name:TEJA
Middle Name:
Last Name:BOGLE
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 1:918 SHARON AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-2328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 W 4TH ST STE 4
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2524
Practice Address - Country:US
Practice Address - Phone:267-370-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide