Provider Demographics
NPI:1760641724
Name:BROGAN, TERRENCE M (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:M
Last Name:BROGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TERRANCE
Other - Middle Name:M
Other - Last Name:BROGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8925 N MERIDIAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2385
Mailing Address - Country:US
Mailing Address - Phone:317-660-4900
Mailing Address - Fax:
Practice Address - Street 1:8925 N MERIDIAN ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2385
Practice Address - Country:US
Practice Address - Phone:317-660-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059977A207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200519870Medicaid
INM400060335Medicare PIN
INM400014999Medicare PIN
IN898190P3Medicare PIN