MEDICARE: JOHN BRENNAN MD

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
1	207ZC0500X	Cytopathology Physician	MD058575L	PA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD058474L	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1710966304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BRENNAN MD

Provider Business Mailing Address
First Line	:	511 RED RIDGE RD
Second Line	:
City	:	ZION GROVE
State	:	PA
Zip	:	17985-9677
Country	:	US
Telephone Number	:	570-384-0716
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 E BROAD ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18201-6835
Country	:	US
Telephone Number	:	570-501-4156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	04/05/2018

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Directions to “ JOHN BRENNAN MD” Practice Location

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