MEDICARE: DR. WILLIAM FREDERICK BRENNAN D.O.

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	207Q00000X	Family Medicine Physician	25MB03184700	NJ

General Provider Information

NPI Number	:	1306884515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM FREDERICK BRENNAN D.O.

Provider Business Mailing Address
First Line	:	2848 S DELSEA DR
Second Line	:	STE 4B
City	:	VINELAND
State	:	NJ
Zip	:	08360-7042
Country	:	US
Telephone Number	:	856-205-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 N BROADWAY
Second Line	:	STE 1
City	:	PITMAN
State	:	NJ
Zip	:	08071-1047
Country	:	US
Telephone Number	:	856-589-3708
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/28/2014

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