Provider Demographics
NPI:1023138708
Name:CREGHAN, BRIAN CHRISTOPHER I (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:CREGHAN
Suffix:I
Gender:M
Credentials:PA-C
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:CHRISTOPHER
Other - Last Name:CREGHAN
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:655 HARMON LOOP RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6544
Mailing Address - Country:US
Mailing Address - Phone:671-588-5268
Mailing Address - Fax:352-481-5750
Practice Address - Street 1:655 HARMON LOOP RD STE 102
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-6544
Practice Address - Country:US
Practice Address - Phone:671-588-5268
Practice Address - Fax:671-989-8836
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101067363A00000X, 363AM0700X
GUPA-128363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant