Provider Demographics
NPI:1295866697
Name:BRENMAN, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:BRENMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SPRUCE STREET
Mailing Address - Street 2:10TH FLOOR-SPRUCE BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6130
Mailing Address - Country:US
Mailing Address - Phone:215-829-7290
Mailing Address - Fax:215-829-5430
Practice Address - Street 1:800 SPRUCE ST
Practice Address - Street 2:10TH FLOOR, SPRUCE BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6130
Practice Address - Country:US
Practice Address - Phone:215-829-7290
Practice Address - Fax:215-829-5430
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028290E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0486098OtherHIGHMARK BLUE SHIELD
PA0030864000OtherIBC
PA0094685OtherAETNA
PA0486098OtherHIGHMARK BLUE SHIELD
PA240005115Medicare PIN
PA0030864000OtherIBC