Provider Demographics
NPI:1881688869
Name:BRANIGAN, MICHAEL P (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:BRANIGAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-2322
Mailing Address - Country:US
Mailing Address - Phone:877-437-3725
Mailing Address - Fax:607-772-1223
Practice Address - Street 1:179 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1019
Practice Address - Country:US
Practice Address - Phone:607-849-4128
Practice Address - Fax:607-849-4891
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY388488367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC4518Medicare ID - Type Unspecified
P25910Medicare UPIN