Provider Demographics
NPI:1992875124
Name:BRENNER, ROBERT SCOTT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:BRENNER
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 1:3733 PARK EAST DRIVE
Mailing Address - Street 2:105
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4337
Mailing Address - Country:US
Mailing Address - Phone:216-504-0001
Mailing Address - Fax:216-504-0005
Practice Address - Street 1:3733 PARK EAST DRIVE
Practice Address - Street 2:105
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4337
Practice Address - Country:US
Practice Address - Phone:216-504-0001
Practice Address - Fax:216-504-0005
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031730207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0313342Medicaid
A73393Medicare UPIN
OHBR0359082Medicare ID - Type Unspecified