Provider Demographics
NPI:1295700144
Name:VOGEL, BRUCE IRA (DPM)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:IRA
Last Name:VOGEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3860
Mailing Address - Country:US
Mailing Address - Phone:703-368-7166
Mailing Address - Fax:703-368-5103
Practice Address - Street 1:8577 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3860
Practice Address - Country:US
Practice Address - Phone:703-368-7166
Practice Address - Fax:703-368-5103
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000297213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
35564OtherUNITED HEALTH CARE
A8890003OtherCAREFIRST BCBS
010300297OtherUNITED HEALTHCARE
35564OtherMAMSI
480000291OtherMEDICARE TRAILBLAZERS
VACC5940OtherRAILROAD MEDICARE GROUP
4800113111OtherRAILROAD MEDICARE
0442570002OtherDMERC
543846OtherAETNA
090283OtherANTHEM BCBS
VA9331476Medicaid
090283OtherANTHEM BCBS
A8890003OtherCAREFIRST BCBS