Provider Demographics
NPI:1659489060
Name:BRENNAN, HERBERT J (DO)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:J
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2358 SOUTH COUNTY TRAIL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818
Mailing Address - Country:US
Mailing Address - Phone:401-886-6000
Mailing Address - Fax:401-886-6002
Practice Address - Street 1:2358 SOUTH COUNTY TRAIL
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818
Practice Address - Country:US
Practice Address - Phone:401-886-6000
Practice Address - Fax:401-886-6002
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RID000445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000025578OtherBLUE CROSS
0400679OtherUHC
RI401019OtherBLUE CHIP
G22668Medicare UPIN
RI119020286Medicare PIN