Healthcare Provider Details

I. General information

NPI: 1306853783
Provider Name (Legal Business Name): ALICIA ANN BRENNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLAINSBORO RD CHOP CARE NETWORK AT PRINCETON MEDICAL CENTER
PLAINSBORO NJ
08536-1913
US

IV. Provider business mailing address

100 E PENN SQ 9TH FLOOR
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 609-853-7000
  • Fax: 609-497-4173
Mailing address:
  • Phone: 267-425-9234
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08593800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD059050L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: