MEDICARE: DR. SIDNEY BRENNER ASSOCIATES

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		PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0058420001	OTHER	PA	INDEPENDENCE BLUE CROSS
2	0000083477	OTHER	PA	PA. BLUE SHIELD
3	0268562004	OTHER	PA	CIGNA HEALTHCARE

General Provider Information

NPI Number	:	1639178890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SIDNEY BRENNER ASSOCIATES

Provider Business Mailing 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

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	:	PARTNER
Name	:	DR. RICHARD PAUL BRENNER
Credential	:	DO
Telephone Number	:	215-624-2491

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/21/2022

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