Individual provider Active NPI

Paula D. Brenn, M.D.

  • Pediatrics Physician
  • Kennett Square, PA
National Provider Identifier
1184750309
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD045518E Issued in PA
Practice address
731 W Cypress St
Kennett Square, PA 19348-2419
Phone
(610) 444-7550
Fax
(610) 444-4656
NPI assigned
Feb 23, 2007
Last updated
Jan 28, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X C1-0004146 DE
Pediatrics Physician 208000000X MD045518E PA Primary

Addresses

Primary practice location

731 W Cypress St
Kennett Square, PA 19348-2419

Mailing address

105 Vineyard Way Ste 200
West Grove, PA 19390-8849
Phone (610) 444-7550

Other identifiers 1

IdentifierTypeStateIssuer
001207769MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C1-0004146DEMDPediatrics Physician
MD045518EPAMDPediatrics Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1184750309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 VINEYARD WAY STE 200",
            "city": "WEST GROVE",
            "state": "PA",
            "postal_code": "193908849",
            "telephone_number": "610-444-7550",
            "fax_number": "610-444-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 W CYPRESS ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193482419",
            "telephone_number": "610-444-7550",
            "fax_number": "610-444-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRENN",
        "first_name": "PAULA",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-23",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "DE",
            "license": "C1-0004146",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD045518E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001207769",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennett Square, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.