MEDICARE: MR. THOMAS EDWARD BRENNAN JR.

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	163WE0003X	Emergency Registered Nurse	2317410	MA

General Provider Information

NPI Number	:	1336803170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS EDWARD BRENNAN JR.

Provider Business Mailing Address
First Line	:	28 MASON ST
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-3112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 MASON ST
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-3112
Country	:	US
Telephone Number	:	781-454-9519
Fax Number	:

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

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/27/2021

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