Provider Demographics
NPI:1669678116
Name:O'HARE, BRENDAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:B
Last Name:O'HARE
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 1:1115B DOW ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2487
Mailing Address - Country:US
Mailing Address - Phone:615-896-6996
Mailing Address - Fax:615-896-6985
Practice Address - Street 1:1115B DOW ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2487
Practice Address - Country:US
Practice Address - Phone:615-896-6996
Practice Address - Fax:615-896-6985
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD49536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531870Medicaid
TN1531870Medicaid