MEDICARE: DR. BRIAN RICHARD KERRIGAN D.O.

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	207Q00000X	Family Medicine Physician	17399	MS
2	207Q00000X	Family Medicine Physician	241293-1	NY

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

General Provider Information

NPI Number	:	1649274275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN RICHARD KERRIGAN D.O.

Provider Business Mailing Address
First Line	:	50 LEROY ST
Second Line	:
City	:	POTSDAM
State	:	NY
Zip	:	13676-1786
Country	:	US
Telephone Number	:	315-265-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 E MAIN ST
Second Line	:
City	:	CANTON
State	:	NY
Zip	:	13617-1450
Country	:	US
Telephone Number	:	315-261-5870
Fax Number	:

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	03/07/2023

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