Provider Demographics
NPI:1992782700
Name:BOGIN, VLADIMIR I (MD)
Entity type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:I
Last Name:BOGIN
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:PO BOX 1338
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7785
Mailing Address - Country:US
Mailing Address - Phone:360-423-9580
Mailing Address - Fax:360-423-6230
Practice Address - Street 1:3810 PLAZA WAY
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2722
Practice Address - Country:US
Practice Address - Phone:509-221-5980
Practice Address - Fax:509-221-5897
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8283897Medicaid
WA8283897Medicaid
WAH56719Medicare UPIN