Provider Demographics
NPI:1699752162
Name:BOGNET, JOSEPH CONRAD (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CONRAD
Last Name:BOGNET
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:1275 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6207
Practice Address - Country:US
Practice Address - Phone:610-821-2820
Practice Address - Fax:610-821-2859
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 009228L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG83924Medicare UPIN
PA021949Medicare ID - Type Unspecified