Healthcare Provider Details

I. General information

NPI: 1053501189
Provider Name (Legal Business Name): JONATHAN H BRENNER M.D., M.P.H
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 WOOD RD SUITE 301
BRAINTREE MA
02184-2401
US

IV. Provider business mailing address

340 WOOD RD SUITE 301
BRAINTREE MA
02184-2401
US

V. Phone/Fax

Practice location:
  • Phone: 781-356-6200
  • Fax:
Mailing address:
  • Phone: 781-356-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number231894
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: