MEDICARE: DR. BARRY STEVEN BRENNER MD

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	MD021739E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0268562004	OTHER	PA	CIGNA HEALTHCARE
2	0058419000	OTHER	PA	INDEPENDENCE BLUE CROSS
3	19356	OTHER	PA	AENTAUSHEALTHCARE

General Provider Information

NPI Number	:	1710986369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY STEVEN BRENNER MD

Provider Business Mailing Address
First Line	:	455 TINA DR
Second Line	:
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3643
Country	:	US
Telephone Number	:	215-322-2882
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	:	07/17/2005
Last Update Date	:	07/08/2007

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