Provider Demographics
NPI:1952376287
Name:BOGNER, EDWARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:W
Last Name:BOGNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 HIGH ST
Mailing Address - Street 2:STE. 301
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7653
Mailing Address - Country:US
Mailing Address - Phone:207-753-7655
Mailing Address - Fax:207-753-7656
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:STE. 301
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7653
Practice Address - Country:US
Practice Address - Phone:207-753-7655
Practice Address - Fax:207-753-7656
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEMD19607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400119957Medicare UPIN
PAB40095Medicare UPIN