Provider Demographics
NPI:1851301451
Name:BRENNAN, TERRY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ELIZABETH
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2833 LINCOLN STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322
Mailing Address - Country:US
Mailing Address - Phone:219-838-1581
Mailing Address - Fax:219-838-9108
Practice Address - Street 1:2833 LINCOLN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322
Practice Address - Country:US
Practice Address - Phone:219-838-1581
Practice Address - Fax:219-838-9108
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034966207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20001382OAMedicaid
C25491Medicare UPIN
IN20001382OAMedicaid