MEDICARE: STEPHEN 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	207R00000X	Internal Medicine Physician	17408	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010017408CT03	OTHER	CT	BLUE CROSS BLUE SHIELD
2	NHP118	OTHER	CT	OXFORD
3	1051333	OTHER	CT	AETNA
4	757491	OTHER	CT	CONNECTICARE

General Provider Information

NPI Number	:	1730188764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN BRENNER MD

Provider Business Mailing Address
First Line	:	2989 DIXWELL AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-3501
Country	:	US
Telephone Number	:	203-248-3013
Fax Number	:	203-248-2878

Provider Business Practice Location Address
First Line	:	129 YORK ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-5608
Country	:	US
Telephone Number	:	203-789-8888
Fax Number	:

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	01/24/2013

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