Healthcare Provider Details

I. General information

NPI: 1235138769
Provider Name (Legal Business Name): RICHARD PAUL BRENNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 KNORR ST
PHILADELPHIA PA
19149-2307
US

IV. Provider business mailing address

2175 KNORR ST
PHILADELPHIA PA
19149-2307
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-2491
  • Fax: 215-624-4259
Mailing address:
  • Phone: 215-338-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS003538L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: