Provider Demographics
NPI:1134330905
Name:BRAUN, MARCIA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELIZABETH
Last Name:BRAUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9015
Mailing Address - Country:US
Mailing Address - Phone:419-483-7240
Mailing Address - Fax:419-483-2543
Practice Address - Street 1:1255 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9015
Practice Address - Country:US
Practice Address - Phone:419-483-7240
Practice Address - Fax:419-483-2543
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57010677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2844015Medicaid
OHBR4238931Medicare UPIN