Provider Demographics
NPI:1588848006
Name:BRENNEMAN, TERRY RICHARD (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:RICHARD
Last Name:BRENNEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 CREEDMOOR RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2310
Mailing Address - Country:US
Mailing Address - Phone:919-787-9555
Mailing Address - Fax:919-510-5111
Practice Address - Street 1:5816 CREEDMOOR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2310
Practice Address - Country:US
Practice Address - Phone:919-787-9555
Practice Address - Fax:919-510-5111
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18164OtherBLUE CROSS