Provider Demographics
NPI:1922054758
Name:BRENEMAN, JOHN W (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:BRENEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-0584
Mailing Address - Country:US
Mailing Address - Phone:717-263-4999
Mailing Address - Fax:717-263-5522
Practice Address - Street 1:405 PHOENIX DR
Practice Address - Street 2:UNIT A
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4534
Practice Address - Country:US
Practice Address - Phone:717-263-4999
Practice Address - Fax:717-263-5522
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD010487E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABR132293OtherHIGHMARK BCBS
PABR132293OtherHIGHMARK BCBS