Provider Demographics
NPI:1326300187
Name:BROGAN, CRYSTAL AJA (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:AJA
Last Name:BROGAN
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:AJA
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 561
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-642-7714
Mailing Address - Fax:610-649-0761
Practice Address - Street 1:100 E LANCASTER AVE STE 561
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3436
Practice Address - Country:US
Practice Address - Phone:610-642-7714
Practice Address - Fax:610-649-0761
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458067207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology