Provider Demographics
NPI:1518476498
Name:BROGAN, RYAN PATRICK (NP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:BROGAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:P
Other - Last Name:BROGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 CHANDLER RD
Mailing Address - Street 2:
Mailing Address - City:EAST SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02537-1730
Mailing Address - Country:US
Mailing Address - Phone:516-395-6751
Mailing Address - Fax:
Practice Address - Street 1:45 RESNIK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4844
Practice Address - Country:US
Practice Address - Phone:508-746-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-24
Last Update Date:2017-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2266515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily