Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | D0056708 | MD |
Y | 208000000X | Pediatrician | D0056708 | MD |
NPI | 1770571226 |
---|---|
Provider Name | Dr. Michele E Brenner |
First Address | Baltimore, MD 21264-4262 |
Second Address | Annapolis, MD 21401-3280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 01/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006 | CAREFIRST (01) | |
10752 | JHHC (01) | |
226883 | KAISER (01) | |
60890501 | BCBS (01) | MD |
60890501 | CAREFIRST (01) | |
973701400 | (05) | MD |
Y1220002 | BCBS (01) | DC |