Provider Demographics
NPI:1215151238
Name:BRENNER, SUSAN J (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:BRENNER
Suffix:
Gender:F
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:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:MC DOWELL
Mailing Address - State:KY
Mailing Address - Zip Code:41647-0578
Mailing Address - Country:US
Mailing Address - Phone:606-285-9234
Mailing Address - Fax:
Practice Address - Street 1:RT 122, BOX 247
Practice Address - Street 2:
Practice Address - City:MC DOWELL
Practice Address - State:KY
Practice Address - Zip Code:41647-0578
Practice Address - Country:US
Practice Address - Phone:606-285-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14023282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital