Provider Demographics
NPI:1922055078
Name:BRENNEMAN, GEORGE R (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:BRENNEMAN
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 1:719 MAIDEN CHOICE LANE,
Mailing Address - Street 2:APT. BR441
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5101
Mailing Address - Country:US
Mailing Address - Phone:410-242-1904
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 47 & 34
Practice Address - Street 2:
Practice Address - City:FT. THOMPSON
Practice Address - State:SD
Practice Address - Zip Code:57339-0200
Practice Address - Country:US
Practice Address - Phone:605-245-2285
Practice Address - Fax:605-245-2384
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4656208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics