Provider Demographics
NPI:1851889992
Name:O'GORMAN, BRIGID DEWITT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIGID
Middle Name:DEWITT
Last Name:O'GORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8274 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14057-1104
Mailing Address - Country:US
Mailing Address - Phone:716-575-7282
Mailing Address - Fax:
Practice Address - Street 1:8724 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NY
Practice Address - Zip Code:14057
Practice Address - Country:US
Practice Address - Phone:716-725-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY301295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program