Provider Demographics
NPI:1740365659
Name:BRENNAN, PAIGE JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:JAMES
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 1:79 WAWECUS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2160
Mailing Address - Country:US
Mailing Address - Phone:860-886-2679
Mailing Address - Fax:860-889-2862
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-886-2679
Practice Address - Fax:860-889-2862
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042747207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400003782OtherMEDICARE PTAN