MR. MICHAEL DAHYL BOGGAN M.D. NPI 1003844812

NPI Information

NPI: 1003844812
Provider Name: MR. MICHAEL DAHYL BOGGAN, M.D.
Classification: General Practice - 208D00000X
Entity Type: Individual
Address:
111 W STONE DR
SUITE 100
KINGSPORT, TN
ZIP 37660
Phone: (423) 247-5197
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MR. Michael Dahyl Boggan, M.D. is a general practice in Kingsport, TN. MR. Michael Dahyl Boggan, M.D. NPI is 1003844812. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

111 W STONE DR
SUITE 100
KINGSPORT, TN
ZIP 37660-027
Phone: (423) 247-5197
Fax: (423) 247-5254

The enumeration date for this NPI number is 6/29/2006 and was last updated on 8/6/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		0101246769	VIRGINIA	No
2	208D00000X	General Practice		21139	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	010199743	MEDICAID	VIRGINIA
2	3057903	MEDICAID	TENNESSEE
3	P00195517	MEDICARE PIN	GEORGIA
4	103I933185	MEDICARE PIN	TENNESSEE
5	C05950	MEDICARE PIN	VIRGINIA
6	VAA101322	MEDICARE PIN	VIRGINIA
7	3057903	MEDICARE PIN	TENNESSEE
8	P00262488	MEDICAID	KENTUCKY
9	65906208	MEDICAID	KENTUCKY
10	3700107	MEDICARE PIN	TENNESSEE
11	1000908	MEDICAID	TENNESSEE
12	103I332924	MEDICARE PIN	TENNESSEE
13	V V3877B	MEDICARE PIN	VIRGINIA
14	V V3877A	MEDICARE PIN	VIRGINIA
15	Z101	OTHER	TENNESSEE	UNITED HEALTHCARE OF THE RIVER VALLEY
16	103G477120	MEDICARE PIN	TENNESSEE
17	3287305	MEDICARE PIN	TENNESSEE
18	621112685	OTHER	TENNESSEE	UNITED HEALTH CARE
19	D64913	MEDICARE UPIN	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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