Provider Demographics
NPI:1629664099
Name:GROGAN, DONALD PATRICK (20191248P)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:PATRICK
Last Name:GROGAN
Suffix:
Gender:M
Credentials:20191248P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FLOPPY DR
Mailing Address - Street 2:
Mailing Address - City:RICHBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29729-9310
Mailing Address - Country:US
Mailing Address - Phone:803-789-3448
Mailing Address - Fax:803-789-3448
Practice Address - Street 1:909 FLOPPY DR
Practice Address - Street 2:
Practice Address - City:RICHBURG
Practice Address - State:SC
Practice Address - Zip Code:29729-9310
Practice Address - Country:US
Practice Address - Phone:803-789-3448
Practice Address - Fax:803-789-3448
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20191248P374U00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCR58815462OtherBLUE CROSS BLUE SHIELD