Healthcare Provider Details

I. General information

NPI: 1316117815
Provider Name (Legal Business Name): EDWARD P BRENNAN II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL PLZ
GRAFTON WV
26354-1283
US

IV. Provider business mailing address

1 HOSPITAL PLZ
GRAFTON WV
26354-1283
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-0400
  • Fax:
Mailing address:
  • Phone: 304-265-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number2262
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number2262
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2262
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: