Provider Demographics
NPI:1891291738
Name:BLAGBROUGH, BRENDAN (DO)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:BLAGBROUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 NORTH RD
Mailing Address - Street 2:MIDHUDSON REGIONAL HOSPITAL -DEPT OF EMERGENCY MEDICINE
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601
Mailing Address - Country:US
Mailing Address - Phone:845-431-8220
Mailing Address - Fax:
Practice Address - Street 1:241 NORTH RD
Practice Address - Street 2:MIDHUDSON REGIONAL HOSPITAL -DEPT OF EMERGENCY MEDICINE
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-431-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-31
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY316105207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program