Basic Information
| Provider Information | |||||||||
| NPI: | 1336241330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATT-BOGUT | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2325 MARYLAND RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159579250 | ||||||||
| FaxNumber: | 2159579254 | ||||||||
| Practice Location | |||||||||
| Address1: | 2325 MARYLAND RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159579250 | ||||||||
| FaxNumber: | 2159579254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 10/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA051199 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.