Provider Demographics
NPI:1679034136
Name:ALLISON, BRENDAN STEPHEN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:STEPHEN
Last Name:ALLISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:331 VERANDA STREET
Mailing Address - Street 2:PO BOX 9746
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-5040
Mailing Address - Country:US
Mailing Address - Phone:207-791-3864
Mailing Address - Fax:
Practice Address - Street 1:331 VERANDA ST BLDG 6
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5545
Practice Address - Country:US
Practice Address - Phone:207-828-2402
Practice Address - Fax:207-828-2433
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine