Provider Demographics
NPI:1578524724
Name:BROGDEN, STEPHANIE JANET (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JANET
Last Name:BROGDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 SE INDUSTRY DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-5023
Mailing Address - Country:US
Mailing Address - Phone:252-492-8576
Mailing Address - Fax:252-492-7464
Practice Address - Street 1:1209 SE INDUSTRY DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-5023
Practice Address - Country:US
Practice Address - Phone:252-492-8576
Practice Address - Fax:252-492-7464
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051437174400000X
NC9900437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA051437OtherGEORGIA LICENSE NUMBER
GA000964224BMedicaid
NC9900437OtherNORTH CAROLINA LICENSE NU
NC1578524724Medicaid
BB6390924OtherDEA NUMBER
BB6390924OtherDEA NUMBER