Provider Demographics
NPI:1851733075
Name:FENNESSY, BRENDAN GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:GERARD
Last Name:FENNESSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:885 UNION ST
Mailing Address - Street 2:STE 145
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3083
Mailing Address - Country:US
Mailing Address - Phone:207-973-9595
Mailing Address - Fax:207-973-9595
Practice Address - Street 1:43 WHITING HILL RD
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1005
Practice Address - Country:US
Practice Address - Phone:207-973-5000
Practice Address - Fax:207-973-5042
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2014-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEMD20186207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology