Provider Demographics
NPI:1982615506
Name:BRENNER, GAIL B (AUD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:B
Last Name:BRENNER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BALA AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3317
Mailing Address - Country:US
Mailing Address - Phone:610-747-1100
Mailing Address - Fax:610-747-1118
Practice Address - Street 1:143 BALA AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3317
Practice Address - Country:US
Practice Address - Phone:610-747-1100
Practice Address - Fax:610-747-1118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000123L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0844536000OtherINDIVIDUAL HMO ID
PA2146958000OtherHMO ID
PA084341Medicare ID - Type Unspecified