Individual
RANDY BOGGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 FAIRFIELD DR, SENECA, PA 16346-2130
(814) 676-7600
Mailing address
453 MONTE KARLO RD, MARBLE, PA 16334-1315
(814) 782-3274
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
58-000326
OH
207P00000X
Emergency Medicine Physician
Primary
OS-010851-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019090460004
—
PA
05
—
0019090460005
—
PA
05
—
0019090460006
—
PA
Enumeration date
07/13/2006
Last updated
04/17/2008
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