Provider Demographics
NPI:1700955846
Name:BOGDANOVA, OLGA L (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:L
Last Name:BOGDANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1146
Mailing Address - Country:US
Mailing Address - Phone:256-492-3571
Mailing Address - Fax:256-438-5069
Practice Address - Street 1:820 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1146
Practice Address - Country:US
Practice Address - Phone:256-492-3571
Practice Address - Fax:256-494-5028
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL274922084S0012X
AL000274922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938953Medicaid
AL51537462OtherBC/BS OF ALABAMA
AL051558172OtherMEDICARE