Healthcare Provider Details

I. General information

NPI: 1952328411
Provider Name (Legal Business Name): SUSAN BRENNAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

282 SCARLET CIR
DOVER DE
19904-5654
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax:
Mailing address:
  • Phone: 302-736-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS011109L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT-006596T
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberTP-0002840 TEMP
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC2-0007293
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: