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1356344626

NPI Code Detail

MEDICARE: DR. BRIAN B BRUGGEMAN MD

MEDICARE: DR. BRIAN B BRUGGEMAN 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	208200000X	Plastic Surgery Physician	MD485999	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
11	POOOO4401	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	18032746	OTHER	AZ	STATE COMP FUND AZ
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	31346	OTHER	AZ	STATE LICENSE AZ
8	8607474153011	OTHER	AZ	TAX ID
9	AZ0734420	OTHER	AZ	BLUE CROSS BLUE SHIELD AZ
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	8640234	OTHER	AZ	CIGNA
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356344626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN B BRUGGEMAN MD

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-9803
Country	:	US
Telephone Number	:	570-808-6400
Fax Number	:	570-808-6338

Provider Business Practice Location Address
First Line	:	675 BALTIMORE DR
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-7900
Country	:	US
Telephone Number	:	570-808-6400
Fax Number	:	570-808-6338

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/02/2026

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Directions to “ DR. BRIAN B BRUGGEMAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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