Provider Demographics
NPI:1225051279
Name:BRICKMAN, TODD MARTIN (PHD/MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MARTIN
Last Name:BRICKMAN
Suffix:
Gender:M
Credentials:PHD/MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 NILES CORTLAND RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1055
Mailing Address - Country:US
Mailing Address - Phone:330-856-2520
Mailing Address - Fax:330-856-2530
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE B
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-856-2520
Practice Address - Fax:330-856-2530
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204958207Y00000X
OH35.133855207YX0007X, 207YX0905X, 207Y00000X
MO2007018704207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392459Medicaid
LA2167405Medicaid
LA2167405Medicaid