Individual
BENJAMIN J BROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5875 BREMO RD STE 400B, RICHMOND, VA 23226-1928
(804) 287-7840
(804) 287-7845
Mailing address
PO BOX 639969, CINCINNATI, OH 45263-9969
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
0110001372
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
07/14/2006
Last updated
10/26/2023
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