Healthcare Provider Details

I. General information

NPI: 1902241441
Provider Name (Legal Business Name): BRENDEN DAVID CONNOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 LIMESTONE RD STE 7
WILMINGTON DE
19808
US

IV. Provider business mailing address

942 ORMOND AVE
DREXEL HILL PA
19026-2606
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-2383
  • Fax: 302-351-6261
Mailing address:
  • Phone: 609-234-8988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT015377
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOT015377
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC2-0012657
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: