Provider Demographics
NPI:1659398477
Name:BRENNAN, SIRISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SIRISHA
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SIRISHA
Other - Middle Name:
Other - Last Name:NERALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10128 W BROAD ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6761
Mailing Address - Country:US
Mailing Address - Phone:804-955-4852
Mailing Address - Fax:855-392-9700
Practice Address - Street 1:10128 W BROAD ST
Practice Address - Street 2:SUITE J
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6761
Practice Address - Country:US
Practice Address - Phone:804-955-4852
Practice Address - Fax:855-392-9700
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242464207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016079B68Medicare PIN