Provider Demographics
NPI:1902892904
Name:GHEORGHIU, BOGDAN P (MD)
Entity type:Individual
Prefix:
First Name:BOGDAN
Middle Name:P
Last Name:GHEORGHIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 BOILING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2201
Mailing Address - Country:US
Mailing Address - Phone:864-577-9107
Mailing Address - Fax:
Practice Address - Street 1:1071 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2201
Practice Address - Country:US
Practice Address - Phone:864-577-9107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC193242084N0400X
NY1927452084N0400X
NC2006-000882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G24796Medicare UPIN