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NPI Code Detail

MEDICARE: DR. CARLO GENNARO BROGNA M.D.

MEDICARE: DR. CARLO GENNARO BROGNA M.D.
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
12084N0400XNeurology Physician23773NH
22084N0400XNeurology PhysicianMD07007RI
32084N0400XNeurology PhysicianEL211147ME
42084N0400XNeurology PhysicianMD25617ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1010007007RI01OTHERRIANTHEM
22069-7OTHERRIRI BC&BS
3R002168OTHERRITRICARE
40R0237OTHERRIHEALTHNET
5200114OTHERRIRI BLUE CHIP
6RI7007OTHERRISTATE MEDICAL LICENSE

General Provider Information

NPI Number : 1467434241
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLO GENNARO BROGNA M.D.
Provider Business Mailing Address
First Line : PO BOX 468
Second Line :
City : SKOWHEGAN
State : ME
Zip : 04976-0468
Country : US
Telephone Number : 207-474-6943
Fax Number : 207-474-6946
Provider Business Practice Location Address
First Line : 46 FAIRVIEW AVE STE 114
Second Line :
City : SKOWHEGAN
State : ME
Zip : 04976-1481
Country : US
Telephone Number : 207-474-6943
Fax Number : 207-474-6946
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2005
Last Update Date : 02/08/2024

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