Provider Demographics
NPI:1386735744
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:WESLEY
Authorized Official - Last Name:BRENNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-792-1811
Mailing Address - Street 1:54 S FORREST ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-5550
Mailing Address - Country:US
Mailing Address - Phone:717-792-1811
Mailing Address - Fax:717-792-3669
Practice Address - Street 1:54 S FORREST ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-5550
Practice Address - Country:US
Practice Address - Phone:717-792-1811
Practice Address - Fax:717-792-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-012261207Q00000X
PAOS-012651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I03192Medicare UPIN
PAI35919Medicare UPIN