Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 27515 | SC |
NPI | 1033102538 |
---|---|
Provider Name | Carol Ann Bogdan |
First Address | Murrells Inlet, SC 29576-1209 |
Second Address | Georgetown, SC 29440-7764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275152 | (05) | SC |
5900387 | (05) | NC |
H52718 | (02) |