Provider Demographics
NPI:1902828254
Name:BRENNAN, MICHAEL W (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BRENNAN
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 1:1016 KIRKPATRICK ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9714
Mailing Address - Country:US
Mailing Address - Phone:336-228-0254
Mailing Address - Fax:336-584-0101
Practice Address - Street 1:1016 KIRKPATRICK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9714
Practice Address - Country:US
Practice Address - Phone:336-228-0254
Practice Address - Fax:336-584-0101
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC26201207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7918158Medicaid
NC0366180016Medicare NSC
NCC82960Medicare UPIN
NC204999DMedicare PIN
NC0366180001Medicare NSC