Individual
ALFRED R. BOGUCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3998 RED LION RD, SUITE 211, PHILADELPHIA, PA 19114-1445
(215) 824-4559
(215) 612-9220
Mailing address
P. O. BOX 8500 - 6335, PHILADELPHIA, PA 19178-6335
(215) 807-8000
(215) 612-9220
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
MD042361E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014120170011
—
PA
01
—
01412017-02
AMERICHOICE
PA
01
—
020030561
RAILROAD MEDICARE
PA
01
—
065584000
KEYSTONE IBC
PA
01
—
1105258
CIGNA
PA
01
—
1555030
UNITED HEALTHCARE
PA
01
—
20045179
AMERIHEALTH
PA
01
—
30017961
KEYSTONE MERCY
PA
01
—
34799
HEALTH PARTNERS
PA
01
—
3658357
AETNA HMO
PA
01
—
746506
HIGHMARK BLUE SHIELD
PA
01
—
PA0025546
TRICARE
PA
Enumeration date
07/01/2006
Last updated
09/29/2011
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