Provider Demographics
NPI:1477529006
Name:BRUNELLE, KERMIT BRION (MD)
Entity Type:Individual
Prefix:
First Name:KERMIT
Middle Name:BRION
Last Name:BRUNELLE
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 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4855
Mailing Address - Fax:
Practice Address - Street 1:14 BALDWIN LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-4227
Practice Address - Country:US
Practice Address - Phone:603-661-6289
Practice Address - Fax:603-471-2537
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-01293208000000X
MN67822208000000X
PAMD466750208000000X
NH8408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH29587OtherCIGNA - HEALTHSOURCE
NH020518021OtherCIGNA
NH020518021OtherONE HEALTH - GREAT WEST
NH020518021OtherUNITED HEALTHCARE
NH020518021OtherTRI CARE
NH2375234OtherAETNA HMO
NH4570918OtherAETNA - NON HMO
NH020518021OtherHCVM
NH204146OtherHARVARD
NH0105100YPNH01OtherANTHEM BLUE CROSS
NH3094016Medicaid
NHE68458Medicare UPIN