Provider Demographics
NPI:1417940735
Name:BRENNAN, LAWRENCE V (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:V
Last Name:BRENNAN
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 636324
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6324
Mailing Address - Country:US
Mailing Address - Phone:859-301-4000
Mailing Address - Fax:859-301-4001
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-4000
Practice Address - Fax:859-301-4001
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20184207RH0003X, 207RX0202X
IN01032565A207RH0003X
OH35048858207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64201841Medicaid
OH0517613Medicaid
KY900003562OtherMEDICARE RAILROAD
IN200070370Medicaid
OH900003532OtherMEDICARE RAILROAD
IN900003553OtherMEDICARE RAILROAD
KY900003562OtherMEDICARE RAILROAD
IN200070370Medicaid
KY64201841Medicaid
IN900003553OtherMEDICARE RAILROAD