Provider Demographics
NPI:1629185905
Name:BRUNSWICK OB-GYN, P.A.
Entity type:Organization
Organization Name:BRUNSWICK OB-GYN, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-520-6730
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-0679
Mailing Address - Country:US
Mailing Address - Phone:910-755-5261
Mailing Address - Fax:910-755-5263
Practice Address - Street 1:116 DURHAM ST STE 205
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-1909
Practice Address - Country:US
Practice Address - Phone:910-755-5261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014P1Medicaid
NC0256UOtherBCBS NC
NC0256UOtherBCBS NC
NC=========OtherMISC COMMERCIAL