Provider Demographics
NPI:1033002233
Name:BOGGS, BRADLEY (CPRS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BOGGS
Suffix:
Gender:M
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 TOD PL NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2475
Mailing Address - Country:US
Mailing Address - Phone:216-777-9303
Mailing Address - Fax:216-972-4788
Practice Address - Street 1:1212 TOD PL NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2475
Practice Address - Country:US
Practice Address - Phone:216-777-9303
Practice Address - Fax:216-972-4788
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006449175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist