Provider Demographics
NPI:1518074889
Name:REGAN, OWEN T (MD)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:T
Last Name:REGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OWEN
Other - Middle Name:THOMAS
Other - Last Name:REGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 78336
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20013-9336
Mailing Address - Country:US
Mailing Address - Phone:910-755-5261
Mailing Address - Fax:
Practice Address - Street 1:12502 WILLOWBROOK RD STE 550
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6594
Practice Address - Country:US
Practice Address - Phone:301-723-3940
Practice Address - Fax:301-723-3491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501389207Q00000X, 207V00000X, 2085U0001X, 208600000X, 208800000X, 208D00000X
MDD73166207V00000X
FLME0063983207V00000X
VA0101249317207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCG497BMedicare PIN
NCP00010672OtherRAILROAD MCR
NC061650569OtherMISC. COMMERCIAL PRIMARY
NC70703OtherBCBS NC
F66088Medicare UPIN
NC8970703Medicaid
2218333COtherMEDICARE PROVIDER NUMBER