Provider Demographics
NPI:1366517625
Name:BOGRAD, SUSAN BEAUSOLEIL (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:BEAUSOLEIL
Last Name:BOGRAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 EAST FIRST AVENUE
Mailing Address - Street 2:SUITE 590
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5818
Mailing Address - Country:US
Mailing Address - Phone:303-320-1968
Mailing Address - Fax:303-322-2155
Practice Address - Street 1:3300 EAST FIRST AVENUE
Practice Address - Street 2:SUITE 590
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5818
Practice Address - Country:US
Practice Address - Phone:303-320-1968
Practice Address - Fax:303-322-2155
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO343632084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
11071Medicare ID - Type Unspecified
E15038Medicare UPIN