Provider Demographics
NPI:1457495848
Name:PELLICANE, BRENDA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:LEE
Last Name:PELLICANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:LEE
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11300 ROCKVILLE PIKE STE 911
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3034
Mailing Address - Country:US
Mailing Address - Phone:301-810-3600
Mailing Address - Fax:313-429-7931
Practice Address - Street 1:11300 ROCKVILLE PIKE STE 911
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3034
Practice Address - Country:US
Practice Address - Phone:301-810-3600
Practice Address - Fax:313-429-7931
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD0075639207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program