Provider Demographics
NPI:1306054721
Name:FAMILY MEDICINE ASSOCIATES OF YORK, LLC
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-927-8434
Mailing Address - Street 1:10 MUDDY CREEK FORKS RD STE 3
Mailing Address - Street 2:P.O. BOX 136
Mailing Address - City:BROGUE
Mailing Address - State:PA
Mailing Address - Zip Code:17309-9497
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 MUDDY CREEK FORKS RD STE 3
Practice Address - Street 2:
Practice Address - City:BROGUE
Practice Address - State:PA
Practice Address - Zip Code:17309-9497
Practice Address - Country:US
Practice Address - Phone:717-927-8434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty