Provider Demographics
NPI:1205910619
Name:BOHM, RALPH ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ARTHUR
Last Name:BOHM
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 1:19 TREE HOLLOW LANE
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6315
Mailing Address - Country:US
Mailing Address - Phone:631-586-3873
Mailing Address - Fax:631-586-3873
Practice Address - Street 1:1 RABRO DRIVE
Practice Address - Street 2:
Practice Address - City:HAVPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-586-3873
Practice Address - Fax:631-586-3873
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0858202084P0800X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1001320810460Medicaid
26578Medicare ID - Type Unspecified
00207611027000Medicare ID - Type Unspecified
NY1001320810460Medicaid