Healthcare Provider Details

I. General information

NPI: 1598389355
Provider Name (Legal Business Name): LAUREN E BRENNAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 PRESIDENTIAL BLVD PH 24
BALA CYNWYD PA
19004-1213
US

IV. Provider business mailing address

191 PRESIDENTIAL BLVD PH 24
BALA CYNWYD PA
19004-1213
US

V. Phone/Fax

Practice location:
  • Phone: 215-774-1306
  • Fax: 866-489-3869
Mailing address:
  • Phone: 215-774-1306
  • Fax: 866-489-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062528
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: