Provider Demographics
NPI:1508828377
Name:BREMNOR, JUDY DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:DEBRA
Last Name:BREMNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BEAR POPLAR RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013-9411
Mailing Address - Country:US
Mailing Address - Phone:704-326-5250
Mailing Address - Fax:704-326-5248
Practice Address - Street 1:210 BEAR POPLAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-9411
Practice Address - Country:US
Practice Address - Phone:704-326-5250
Practice Address - Fax:704-326-5248
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891317PMedicaid
NC891317PMedicaid