Provider Demographics
NPI:1174551642
Name:SENNETT, BRIAN JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JEFFREY
Last Name:SENNETT
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 1:235 S 33RD ST
Mailing Address - Street 2:WEIGHTMAN HALL, 1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-6322
Mailing Address - Country:US
Mailing Address - Phone:215-615-4400
Mailing Address - Fax:215-615-4405
Practice Address - Street 1:235 S 33RD ST
Practice Address - Street 2:WEIGHTMAN HALL, 1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-6322
Practice Address - Country:US
Practice Address - Phone:215-615-4400
Practice Address - Fax:215-615-4405
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045507L207X00000X, 207RS0010X
NJ25MA06166400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001492125Medicaid
PA555916Medicare PIN
PA001492125Medicaid