Provider Demographics
NPI:1184896722
Name:HERBERT J BRENNAN DO LTD
Entity type:Organization
Organization Name:HERBERT J BRENNAN DO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-886-6000
Mailing Address - Street 1:2358 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1500
Mailing Address - Country:US
Mailing Address - Phone:401-886-6000
Mailing Address - Fax:401-886-6002
Practice Address - Street 1:2358 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1500
Practice Address - Country:US
Practice Address - Phone:401-886-6000
Practice Address - Fax:401-886-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000025578OtherRI BLUE SHIELD
RI401019OtherBLUE CHIP
RI9020286Medicaid
RI04-00679OtherUNITED HEALTH CARE
RI119006167Medicare PIN
RI04-00679OtherUNITED HEALTH CARE