Provider Demographics
NPI:1841276284
Name:BOGDANY, RICA SALMON (MD)
Entity type:Individual
Prefix:DR
First Name:RICA
Middle Name:SALMON
Last Name:BOGDANY
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 1:427 KASSIK CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5811
Mailing Address - Country:US
Mailing Address - Phone:407-766-6924
Mailing Address - Fax:407-240-2635
Practice Address - Street 1:427 KASSIK CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-5811
Practice Address - Country:US
Practice Address - Phone:407-766-6924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14420207Q00000X, 207Q00000X
FL58520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11379Medicare ID - Type Unspecified
FLE20737Medicare UPIN