Provider Demographics
NPI:1679859250
Name:EGGAN, BRITTANIE LEE (PA)
Entity Type:Individual
Prefix:
First Name:BRITTANIE
Middle Name:LEE
Last Name:EGGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRITTANIE
Other - Middle Name:LEE
Other - Last Name:SATHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:985 PRINCE FREDERICK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:985 PRINCE FREDERICK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3492
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003316363A00000X
CA54397363A00000X
COPA.0008320363A00000X
NY031178363A00000X
MDC0009246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067803Medicaid
FL010866700Medicaid
CA54397OtherLIC
OHH054870Medicare PIN