MEDICARE: MAUREEN BROGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	204688	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400062882	OTHER	NY	MEDICARE PTAN
3	A400062887	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053311209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN BROGAN MD

Provider Business Mailing Address
First Line	:	3411 WAYNE AVE FL 5
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2535
Country	:	US
Telephone Number	:	718-920-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 BAINBRIDGE AVE FL 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2404
Country	:	US
Telephone Number	:	866-633-8255
Fax Number	:	718-231-0293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/09/2023

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Directions to “ MAUREEN BROGAN MD” Practice Location

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