Individual
SONDRA IACULLO BOGURSKY
Active
Individual
SONDRA IACULLO BOGURSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042480
CT
208000000X
Pediatrics Physician
042480
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001424803
—
CT
01
—
010042480CT01
ANTHEM BCBS CT
CT
01
—
24-70412
UHC
CT
01
—
246269
WELLCARE
CT
01
—
3689809/7698594
AETNA
CT
01
—
965608
USA
CT
01
—
PENDING
RAILROAD MEDICARE
CT
Enumeration date
06/25/2006
Last updated
10/19/2021
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