Provider Demographics
NPI:1801996772
Name:BOOGUSCH, ELIZABETH J (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:BOOGUSCH
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 1:17 ROCKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1616
Mailing Address - Country:US
Mailing Address - Phone:207-390-0647
Mailing Address - Fax:207-470-1154
Practice Address - Street 1:17 ROCKBROOK DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1616
Practice Address - Country:US
Practice Address - Phone:207-390-0647
Practice Address - Fax:207-470-1154
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD14769208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69650Medicare UPIN
MEMM7278Medicare ID - Type Unspecified