Provider Demographics
NPI:1467623462
Name:BRIAN T. O'DONOGHUE
Entity Type:Organization
Organization Name:BRIAN T. O'DONOGHUE
Other - Org Name:BRIAN T O'DONOGHUE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:FAMILY PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:O'DONOGHUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-756-2178
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-0032
Mailing Address - Country:US
Mailing Address - Phone:270-756-2178
Mailing Address - Fax:
Practice Address - Street 1:124 W 3RD ST
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2624
Practice Address - Country:US
Practice Address - Phone:270-756-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65900656Medicaid
KYG31030Medicare UPIN
KY65900656Medicaid