Provider Demographics
NPI:1407841901
Name:BRENDESE, JOHN J (MD, FACR)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BRENDESE
Suffix:
Gender:M
Credentials:MD, FACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 LILLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3130
Mailing Address - Country:US
Mailing Address - Phone:704-377-1216
Mailing Address - Fax:704-377-4661
Practice Address - Street 1:332 LILLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3130
Practice Address - Country:US
Practice Address - Phone:704-377-1216
Practice Address - Fax:704-377-4661
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601564207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52132ZMedicare ID - Type Unspecified
FLI22494Medicare UPIN