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General NPI Number Information
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NPI Number | 1417966409
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Entity Type | Individual
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Provider Name | MATHIJS HENRI BRENTJENS MD
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Gender | Male
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 222 VIRGINIA RD
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City | EDENTON
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State | NC
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Zip | 27932-9667
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Country | US
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Telephone | 252-752-4124
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Fax | 252-758-8954
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Provider Business Mailing Address
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Address Line | 420 SPRING FOREST RD
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City | GREENVILLE
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State | NC
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Zip | 27834-7244
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Country | US
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Telephone | 252-752-4124
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Fax | 252-758-8954
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 200500012
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License Number State | NC
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