MARK BRENNAN (NPI# 1174523443) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174523443 |
| Entity Type | Individual |
| Full Name | MARK BRENNAN |
| Credential | DO |
| Practice Address |
30 Harrison St Ste 455 Johnson City NY 13790-2161 |
| Mailing Address |
346 Grand Ave United Medical Associates, PC Johnson City NY 13790-2558 |
| Practice Telephone | 6077638100 |
| Practice Fax Number | 6077638048 |
| Mailing Telephone | 6077638100 |
| Mailing Fax Number | 6077298866 |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2014-09-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 217717 | NY | Allopathic & Osteopathic Physicians |
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
217717 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 02082319 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598033136 | Mark Edward Brennan | Dentist | 882 Backbone Ct, Westminster, MD 21157-7745 | 2011-12-11 |
| 1609178458 | Mark Brennan | Pharmacist | 212 Elks Point Rd, Zephyr Cove, NV 89448-9800 | 2010-11-30 |
| 1326081357 | Mark D Brennan | Anesthesiology | 1600 Haddon Ave, Camden, NJ 08103-3101 | 2006-06-14 |
| 1225001746 | Mark J Brennan | Physical Medicine & Rehabilitation | 43650 Garfield Rd, Clinton Township, MI 48038-7419 | 2006-02-08 |
| Street Address |
30 HARRISON ST STE 455 |
| City | JOHNSON CITY |
| State | NY |
| Zip Code | 13790-2161 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932105566 | Roman Thomas Pachulski | Internal Medicine | 30 Harrison St, Suite 250, Johnson City, NY 13790-2161 | 2005-06-28 |
| 1811488455 | Siddharth Dalal | Internal Medicine | 30 Harrison St, Johnson City, NY 13790 | 2018-05-18 |
| 1316342959 | Jodi Villanti | Nurse Practitioner | 30 Harrison St, Suite 460, Johnson City, NY 13790-2161 | 2014-10-24 |
| 1306277017 | Kara Spalik | Nurse Practitioner | 30 Harrison St, Suite 100, Johnson City, NY 13790-2161 | 2013-12-05 |
| 1033459292 | Jerome H Rosenstein Md Pllc | Specialist | 30 Harrison St, Suite 320, Johnson City, NY 13790-2161 | 2013-02-26 |
| 1881946788 | Karen Lee Dunham | Physician Assistant | 30 Harrison St, Suite 455, Johnson City, NY 13790-2161 | 2012-10-03 |
| 1225325921 | Kimberly Hageman Merrill | Nurse Practitioner | 30 Harrison St, Suite 100, Johnson City, NY 13790-2161 | 2011-07-01 |
| 1023252293 | Michail Vitellas | Internal Medicine | 30 Harrison St, Suite 250, Johnson City, NY 13790 | 2009-04-30 |
| 1063659241 | J Richard Cunningham | Surgery | 30 Harrison St, Suite 455, Johnson City, NY 13790-2161 | 2009-01-09 |
| 1821240011 | Shilpa Sambidi | Internal Medicine | 30 Harrison St, Suite 100, Johnson City, NY 13790-2161 | 2008-10-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578107645 | Thomas William Sorber | Occupational Therapist | 33 Harrison St, Johnson City, Johnson City, NY 13790 | 2019-11-01 |
| 1326534116 | Silver Linings Golden Memory Care | Clinic/Center | 4416 Watson Blvd, Johnson City, NY 13790 | 2018-07-05 |
| 1508308545 | Irene Mukeli Nzasi | Registered Nurse | 156 Corliss Ave Suite 107, Johnson City, NY 13790 | 2016-11-08 |
| 1053867754 | Tabitha Rae Toman | Physical Therapist | 34 Harrison St, Johnson City, NY 13790 | 2016-09-01 |
| 1235685066 | Dianne Brunner | Physical Therapist | 33-55 Harrison Street, Wilson Hospital, Johnson City, NY 13790 | 2016-08-31 |
| 1578982682 | Tracy Lynn Brown | Optometrist | 223 Reynolds Road, Johnson City, NY 13790 | 2014-04-16 |
| 1083041495 | Maryann Serbonich | Pharmacist | 52 Harrison Street, Johnson City, NY 13790 | 2013-09-30 |
| 1134464399 | Kasey Connor Folger | Speech-Language Pathologist | 3 Laurel St., Johnson City, NY 13790 | 2012-11-29 |
| 1467797571 | Bodyworks Physical Therapy LLC | Clinic/Center | 765 Harry L Drive, Johnson City, NY 13790 | 2012-11-29 |
| 1548518400 | Melissa L Korosec | Nurse Practitioner | 30 Harrison St., Suite 250, Johnson City, NY 13790 | 2012-08-27 |
| Find all providers in zip 13790 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760471056 | Steven Paul Hopkins | Surgery | 2428 Knob Creek Rd Ste 201, Johnson City, TN 37604-2396 | 2005-10-19 |
| 1558355511 | Luke Stephan Erdoes | Surgery | 2 Professional Park Dr Ste 11, Johnson City, TN 37604-6584 | 2005-09-07 |
| 1043739881 | Blue Ridge Medical Mangement Corporation | Surgery | 2 Professional Park Dr Ste 11, Johnson City, TN 37604-6584 | 2017-09-13 |
| 1114340445 | Blue Ridge Medical Management | Surgery | 310 N State of Franklin Rd, Suite 101b, Johnson City, TN 37604-6008 | 2014-01-22 |
| 1841499191 | Heesuk Richard Yoon | Surgery | 2428 Knob Creek Rd Ste 201, Johnson City, TN 37604-2396 | 2007-07-17 |
| 1154381713 | Cardiopulmonary Surgical Consultants PC | Surgery | 310 N State of Franklin Rd, Ste 101, Johnson City, TN 37604 | 2006-03-27 |
| 1295724284 | James Robert Evans | Surgery | 310 N State of Franklin Rd, Suite 101b, Johnson City, TN 37604-6008 | 2005-10-21 |
| 1124012109 | Anthony Katras | Surgery | 325 N State of Franklin Rd, 3rd Floor, Johnson City, TN 37604-6062 | 2005-09-07 |
| 1760482863 | Leonard Anderson | Surgery | 30 Harrison St, Suite 455, Johnson City, NY 13790-2161 | 2005-07-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962003509 | Gs Medical, P.C. | Surgery | 377-b Pearsall Ave, Cedarhurst, NY 11516 | 2020-11-02 |
| 1073128971 | New York Vascular Group, Pllc | Surgery | 19 Laurel Ave Ste 102, Cornwall, NY 12518-1403 | 2020-09-09 |
| 1578190179 | Camilo Jose Martinez | Surgery | 23 S Howell Ave Ste H, Centereach, NY 11720-4445 | 2020-03-24 |
| 1407483399 | Interventional Medicine | Surgery | 1122a Coney Island Ave, Brooklyn, NY 11230-2307 | 2020-03-23 |
| 1487287975 | Syracuse Professional Medical Services of New York LLC | Surgery | 1101 Erie Blvd E Ste 201a, Syracuse, NY 13210-1144 | 2020-02-13 |
| 1457983181 | Syracuse Medical of New York LLC | Surgery | 1101 Erie Blvd E Ste 201b, Syracuse, NY 13210-1144 | 2020-02-11 |
| 1366914483 | Star Veins Centers PC | Surgery | 225 W 35th St Frnt 2, New York, NY 10001-1904 | 2018-12-31 |
| 1528547312 | Norwood Professional Medical Services of New York LLC | Surgery | 3487-89 Jerome Ave, Ste A, Bronx, NY 10468 | 2018-08-13 |
| 1336628130 | Norwood Medical of New York LLC | Surgery | 3487-89 Jerome Ave, Ste B, Bronx, NY 10468 | 2018-08-13 |
| 1003393299 | Bushwick Professional Medical Services of New York LLC | Surgery | 441 Knickerbocker Ave Ste A, Brooklyn, NY 11237-4508 | 2018-07-20 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 13790 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.