Provider Demographics
NPI:1376260141
Name:MCANANY, BRIAN JAMES (RDN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:MCANANY
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 CRICKET AVE APT A
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2052
Mailing Address - Country:US
Mailing Address - Phone:484-639-7329
Mailing Address - Fax:
Practice Address - Street 1:815 CRICKET AVE APT A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2052
Practice Address - Country:US
Practice Address - Phone:484-639-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered