Provider Demographics
NPI:1548527492
Name:BROGOCH, LAURA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE
Last Name:BROGOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 E ST NW
Mailing Address - Street 2:SA-1 STE L209 BUREAU OF MEDICAL SERVICES, US DOS
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522
Mailing Address - Country:US
Mailing Address - Phone:415-225-0319
Mailing Address - Fax:
Practice Address - Street 1:2401 E ST NW
Practice Address - Street 2:SA-1 SUITE L209, BUREAU OF MEDICAL SERVICES
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522
Practice Address - Country:US
Practice Address - Phone:415-225-0319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1720672084P0800X
DCMD5000029252084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500655198Medicaid
OR500655198Medicaid