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NPI Code Detail

MEDICARE: MARK BRENNAN DO

MEDICARE: MARK BRENNAN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician217717NY
22086S0129XVascular Surgery Physician217717NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174523443
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK BRENNAN DO
Provider Business Mailing Address
First Line : 346 GRAND AVE
Second Line : UNITED MEDICAL ASSOCIATES, PC
City : JOHNSON CITY
State : NY
Zip : 13790-2558
Country : US
Telephone Number : 607-763-8100
Fax Number : 607-729-8866
Provider Business Practice Location Address
First Line : 30 HARRISON ST
Second Line : STE 455
City : JOHNSON CITY
State : NY
Zip : 13790-2161
Country : US
Telephone Number : 607-763-8100
Fax Number : 607-763-8048
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 09/15/2014

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Directions to “ MARK BRENNAN DO” Practice Location

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