Basic Information
| Provider Information | |||||||||
| NPI: | 1770571226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRENNER | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64262 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816481 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
| FaxNumber: | 4434816588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2005 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | D0056708 | MD | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 208000000X | D0056708 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0006 | 01 | CAREFIRST | OTHER | 226883 | 01 | KAISER | OTHER | 973701400 | 05 | MD | MEDICAID | 60890501 | 01 | MD | BCBS | OTHER | 60890501 | 01 | CAREFIRST | OTHER | 10752 | 01 | JHHC | OTHER | Y1220002 | 01 | DC | BCBS | OTHER |