Provider Demographics
NPI:1851316798
Name:BROGAN, BETSY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:A
Last Name:BROGAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 PLEASANT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-4670
Mailing Address - Country:US
Mailing Address - Phone:513-829-9333
Mailing Address - Fax:513-858-7827
Practice Address - Street 1:2925 VERNON PL
Practice Address - Street 2:SUITE 302
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2425
Practice Address - Country:US
Practice Address - Phone:513-381-4042
Practice Address - Fax:513-345-6632
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-3262B213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00109971OtherRAIL ROAD MEDICARE
OH2404142Medicaid
KY9707Medicare ID - Type UnspecifiedKENTUCKY GROUP NUMBER
OH2404142Medicaid
U85265Medicare UPIN