Provider Demographics
NPI:1366475568
Name:BOHLER, HENRY CABOT LODGE JR (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CABOT LODGE
Last Name:BOHLER
Suffix:JR
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 1:9412 CIVIC WAY APT 210
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-5103
Mailing Address - Country:US
Mailing Address - Phone:502-444-5767
Mailing Address - Fax:
Practice Address - Street 1:9412 CIVIC WAY APT 210
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-5103
Practice Address - Country:US
Practice Address - Phone:502-373-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38316207V00000X, 207VE0102X, 207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200463200Medicaid
KY64924855Medicaid
KY50000609OtherPASSPORT SPECIALTY# - FOUNDATION
KY50011024OtherPASSPORT SPECIALITY - PSC
KY000000299974OtherANTHEM - FOUNDATION
KYE62905Medicare UPIN
KY50000720OtherPASSPORT PCP#-FOUNDATION
IN200463200Medicaid
KY0722507Medicare ID - Type UnspecifiedKENTUCKY MEDICARE (FOUND)
KY1275782Medicare ID - Type Unspecified