Provider Demographics
NPI:1932178811
Name:BOGDASCHEWSKYI, ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:BOGDASCHEWSKYI
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 1:1312 CONQUISTADOR DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3804
Mailing Address - Country:US
Mailing Address - Phone:410-848-9329
Mailing Address - Fax:410-848-5950
Practice Address - Street 1:1011 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7055
Practice Address - Country:US
Practice Address - Phone:410-848-8256
Practice Address - Fax:410-848-5950
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37949173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD544671600Medicaid
MD948M751FMedicare ID - Type Unspecified
MD544671600Medicaid