Provider Demographics
NPI:1043226236
Name:BRENNAN, STEPHEN R (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:109 WOODBRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-363-5437
Mailing Address - Fax:207-351-1722
Practice Address - Street 1:109 WOODBRIDGE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1450
Practice Address - Country:US
Practice Address - Phone:207-363-5437
Practice Address - Fax:207-351-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1333208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2375017OtherAETNA
PA9022900OtherCIGNA NATIONAL
ME00007MOtherANTHEM BLUE CROSS MAINE
NH121460COtherCIGNA HC NH
MAME0081OtherHARVARD PILGRIM HC
NH30220763Medicaid
ME027530OtherANTHEM BX MAINE
NH040854YPME 01OtherMATTHEW THORNTON BLUE NH
NHE39853OtherANTHEM BX NH
MECIGNAOtherM52711C