Provider Demographics
NPI:1053386193
Name:NEUGHEBAUER, BOGDAN IOAN (MD)
Entity type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:IOAN
Last Name:NEUGHEBAUER
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 1:850 KEMPSVILLE RD STE 100F
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3920
Mailing Address - Country:US
Mailing Address - Phone:757-261-5910
Mailing Address - Fax:757-275-9940
Practice Address - Street 1:850 KEMPSVILLE RD STE 100F
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-261-5910
Practice Address - Fax:757-275-9940
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235659207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010029511Medicaid
003236S33Medicare ID - Type Unspecified
VA010029511Medicaid