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1326300187 NPI number — CRYSTAL AJA BROGAN MEDICAL DOCTOR

NPI Number: 1326300187
Health Care Provider/Practitioner: CRYSTAL AJA BROGAN MEDICAL DOCTOR

Information about “1326300187” NPI (CRYSTAL AJA BROGAN MEDICAL DOCTOR) exists in 1326300187 in HTML format HTML  |  1326300187 in plain Text format TXT  |  1326300187 in PDF (Portable Document Format) PDF  |  1326300187 in an XML format XML  formats.

NPI Number : 1326300187 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1326300187",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROGAN",
    "FirstName": "CRYSTAL",
    "MiddleName": "AJA",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MEDICAL DOCTOR",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CRAIG",
    "OtherFirstName": "CRYSTAL",
    "OtherMiddleName": "AJA",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "100 E LANCASTER AVE",
    "SecondLineMailingAddress": "SUITE 561",
    "MailingAddressCityName": "WYNNEWOOD",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19096",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "610-642-7714",
    "MailingAddressFaxNumber": "610-649-0761",
    "FirstLinePracticeLocationAddress": "100 E LANCASTER AVE STE 561",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WYNNEWOOD",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19096-3436",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "610-642-7714",
    "PracticeLocationAddressFaxNumber": "610-649-0761",
    "EnumerationDate": "06/07/2012",
    "LastUpdateDate": "08/04/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207V00000X",
        "TaxonomyName": "Obstetrics & Gynecology Physician",
        "LicenseNumber": "MD458067",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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