| Doctor Name: | SAMANTHA BROGAN |
| NPI Number: | 1164852703 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | R208802 |
| Business Practice Address: | 23511 Hollywood Rd Suite 2 Leonardtown, MD - 206505833 |
| Business Phone Number: | 3019970611 |
| Business Fax Number: | 3019970709 |
| Mailing Address: | Po Box 909, LEONARDTOWN |
| State: | MD |
| Postal Code: | 206500909 |
| Phone Number: | 3019970611 |
| Fax Number: | 3019970709 |
| NPI Enumeration Date: | 11/18/2013 |
| NPI Last Update Date: | 12/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R208802 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |