1851316798 NPI number — DR. BETSY A BROGAN D.P.M

Table of content: DR. BETSY A BROGAN D.P.M (NPI 1851316798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851316798 NPI number — DR. BETSY A BROGAN D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROGAN
Provider First Name:
BETSY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851316798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6200 PLEASANT AVE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45014-4670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-829-9333
Provider Business Mailing Address Fax Number:
513-858-7827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 VERNON PL
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-381-4042
Provider Business Practice Location Address Fax Number:
513-345-6632
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36-00-3262B , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00109971 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2404142 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".