Provider Demographics
NPI:1053311209
Name:BROGAN, MAUREEN (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BROGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3411 WAYNE AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2535
Mailing Address - Country:US
Mailing Address - Phone:718-920-5442
Mailing Address - Fax:
Practice Address - Street 1:3400 BAINBRIDGE AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:866-633-8255
Practice Address - Fax:718-231-0293
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204688207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400062882OtherMEDICARE PTAN
NY02176507Medicaid
NYA400062887OtherMEDICARE PTAN