Provider Demographics
NPI:1720385644
Name:SLOBOGEAN, BRONWYN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRONWYN
Middle Name:
Last Name:SLOBOGEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRONWYN
Other - Middle Name:
Other - Last Name:TRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 N WOLFE ST
Mailing Address - Street 2:PHIPPS 454
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:PHIPPS 454
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-614-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-13
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004444363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical