Individual
DR. GOUTHAMI BOGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 N FRONT ST, WORMLEYSBURG, PA 17043-1021
(717) 731-0101
(717) 731-8359
Mailing address
409 S 2ND ST, SUITE 2F, HARRISBURG, PA 17104-1612
(717) 731-0101
(717) 731-8359
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD451864
PA
207RC0000X
Cardiovascular Disease Physician
Primary
MD451864
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102926581
—
PA
Enumeration date
08/12/2008
Last updated
01/21/2021
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