Provider Demographics
NPI:1407015449
Name:CAROLAN, BRENDAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:J
Last Name:CAROLAN
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:PO BOX 1070
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02722-1070
Mailing Address - Country:US
Mailing Address - Phone:508-676-3292
Mailing Address - Fax:508-672-7181
Practice Address - Street 1:191 BEDFORD STREET
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3050
Practice Address - Country:US
Practice Address - Phone:508-679-4239
Practice Address - Fax:303-270-2174
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP58489207RP1001X
CO49576207RP1001X
MA261626207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61278866Medicaid
CO61278866Medicaid