Provider Demographics
NPI:1346246394
Name:DUGAN, THOMAS MATTHEW JR
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MATTHEW
Last Name:DUGAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3132
Mailing Address - Country:US
Mailing Address - Phone:724-775-8801
Mailing Address - Fax:724-775-0440
Practice Address - Street 1:3452 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3132
Practice Address - Country:US
Practice Address - Phone:724-775-8801
Practice Address - Fax:724-775-0440
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025116E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4059661OtherOHIO MEDICARE INDVIDUAL
PADU144675OtherMEDICARE NUMBER
PA0008350460006Medicaid
PADU144675OtherMEDICARE NUMBER