Provider Demographics
NPI:1144783028
Name:PASSIAS, BRADEN JAMES
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:JAMES
Last Name:PASSIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WIVELISCOMBE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-7601
Mailing Address - Country:US
Mailing Address - Phone:614-395-6012
Mailing Address - Fax:
Practice Address - Street 1:5131 BEACON HILL RD STE 160
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4441
Practice Address - Country:US
Practice Address - Phone:614-544-1837
Practice Address - Fax:614-544-2816
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program