Provider Demographics
NPI:1427288901
Name:BOGDANOVITCH, JENNIFER LEE (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:BOGDANOVITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:SEBASTIANELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-0469
Mailing Address - Country:US
Mailing Address - Phone:508-359-8141
Mailing Address - Fax:508-359-8005
Practice Address - Street 1:266 MAIN ST
Practice Address - Street 2:UNIT 4
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2043
Practice Address - Country:US
Practice Address - Phone:508-359-8141
Practice Address - Fax:508-359-8005
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine