Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 178406 | NY |
N | 2084N0600X | Clinical Neurophysiologist | 178406 | NY |
NPI | 1306895321 |
---|---|
Provider Name | Andrew C Bragdon |
First Address | Syracuse, NY 13202-2240 |
Second Address | Syracuse, NY 13202-2240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 06/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01137439 | (05) | NY |