Healthcare Provider Details

I. General information

NPI: 1184750309
Provider Name (Legal Business Name): PAULA D. BRENN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 W CYPRESS ST
KENNETT SQUARE PA
19348-2419
US

IV. Provider business mailing address

105 VINEYARD WAY STE 200
WEST GROVE PA
19390-8849
US

V. Phone/Fax

Practice location:
  • Phone: 610-444-7550
  • Fax: 610-444-4656
Mailing address:
  • Phone: 610-444-7550
  • Fax: 610-444-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0004146
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD045518E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001207769
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: