Provider Demographics
NPI:1720722200
Name:OGILVIE, BRANDON RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:RICHARD
Last Name:OGILVIE
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 1:109 ROBIN ST APT 32
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3842
Mailing Address - Country:US
Mailing Address - Phone:802-688-3328
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N STE 305
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3893
Practice Address - Country:US
Practice Address - Phone:516-663-2619
Practice Address - Fax:516-663-2261
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program