Individual
AGATA M BOGUSZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, 6.036 GATES, PHILADELPHIA, PA 19104-4238
(215) 615-6510
Mailing address
3400 SPRUCE ST, 6.036 GATES, PHILADELPHIA, PA 19104-4238
(215) 615-6510
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
MD450012
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP1-0026465
INSTITUTIONAL PERMIT
—
Enumeration date
06/09/2007
Last updated
10/15/2013
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