Provider Demographics
NPI:1790870723
Name:BRENA, ANNE E (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:BRENA
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 1:353 BLAIR PARK RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7530
Mailing Address - Country:US
Mailing Address - Phone:802-847-1470
Mailing Address - Fax:
Practice Address - Street 1:353 BLAIR PARK RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7530
Practice Address - Country:US
Practice Address - Phone:802-847-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223593207R00000X
VT042.0012529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP52210OtherEMPIRE BC/BS LEGACY
NY002242639Medicaid
NYP010223593OtherEXCELLUS LEGACY
NY116300OtherMVP LEGACY
NY000499880001OtherBS OF NENY LEGACY
NY7797529OtherAETNA LEGACY
NY000499880001OtherBS OF NENY LEGACY
NY7797529OtherAETNA LEGACY