MEDICARE: DR. RICHARD PAUL BRENNER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	OS003538L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0268562004	OTHER	PA	CIGNA HEALTHCARE
2	0058482000	OTHER	PA	INDEPENDENCE BLUE CROSS
3	19355	OTHER	PA	AETNAUSHEALTHCARE

General Provider Information

NPI Number	:	1235138769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD PAUL BRENNER DO

Provider Business Mailing Address
First Line	:	2175 KNORR ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2307
Country	:	US
Telephone Number	:	215-338-6703
Fax Number	:

Provider Business Practice Location Address
First Line	:	2175 KNORR ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2307
Country	:	US
Telephone Number	:	215-624-2491
Fax Number	:	215-624-4259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/08/2007

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