Provider Demographics
NPI:1558131268
Name:MCGOUGH, BRIA
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:MCGOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 W ANDREWS AVE STE Y
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2500
Mailing Address - Country:US
Mailing Address - Phone:919-339-6739
Mailing Address - Fax:
Practice Address - Street 1:946 W ANDREWS AVE STE Y
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2500
Practice Address - Country:US
Practice Address - Phone:919-339-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies