Provider Demographics
NPI:1306949920
Name:GOGLIN, BRETT W (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:W
Last Name:GOGLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10058 S MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH MOUNTAIN
Mailing Address - State:PA
Mailing Address - Zip Code:17261-0900
Mailing Address - Country:US
Mailing Address - Phone:717-749-3121
Mailing Address - Fax:
Practice Address - Street 1:10058 S MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SOUTH MOUNTAIN
Practice Address - State:PA
Practice Address - Zip Code:17261-0900
Practice Address - Country:US
Practice Address - Phone:717-749-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038577E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110165558Medicare PIN
PA139108Medicare PIN
PAB38900Medicare UPIN