Provider Demographics
NPI:1124038906
Name:HORGAN, BRIAN W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:HORGAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COAL VALLEY RD STE 573
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3729
Mailing Address - Country:US
Mailing Address - Phone:412-267-6282
Mailing Address - Fax:412-267-2683
Practice Address - Street 1:575 COAL VALLEY RD STE 573
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3729
Practice Address - Country:US
Practice Address - Phone:412-267-6282
Practice Address - Fax:412-267-2683
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051155363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11692272OtherCAQH
PA103385477Medicaid
PA067960Medicare ID - Type UnspecifiedMEDICARE