Provider Demographics
NPI:1184669459
Name:ERICA M BRENDEL MD PC
Entity Type:Organization
Organization Name:ERICA M BRENDEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ERICA M BRENDEL MD PC PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-471-1576
Mailing Address - Street 1:111 N 49TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139
Mailing Address - Country:US
Mailing Address - Phone:215-471-1576
Mailing Address - Fax:
Practice Address - Street 1:111 N 49TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:215-471-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019381E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110459Medicare ID - Type Unspecified