Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101051206 | VA |
N | 207ND0900X | Dermatopathologist | 0101051206 | VA |
N | 207NS0135X | Procedural Dermatology | 0101051206 | VA |
NPI | 1790756534 |
---|---|
Provider Name | Dr. Maria A Bogaert |
First Address | Winchester, VA 22601-2803 |
Second Address | Winchester, VA 22601-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 23/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001717410 | MTST BCBS (01) | WV |
005900433 | (05) | VA |
0070048000 | (05) | WV |
019313 | ANTHEM BCBS (01) | VA |
D51849 | (02) | VA |