Provider Demographics
NPI:1316475197
Name:MUGO, BRIAN M (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:MUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3475 ERWIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-0005
Mailing Address - Country:US
Mailing Address - Phone:919-660-6746
Mailing Address - Fax:919-684-0607
Practice Address - Street 1:3475 ERWIN RD STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-0005
Practice Address - Country:US
Practice Address - Phone:919-660-6746
Practice Address - Fax:919-684-0607
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA271081207R00000X
NC2024-03350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine