Provider Demographics
NPI:1396035457
Name:BLACKWELL-FORD, BRANDY N (MD)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:N
Last Name:BLACKWELL-FORD
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 1:3333 BURNET AVENUE
Mailing Address - Street 2:ML 5018
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3909
Mailing Address - Country:US
Mailing Address - Phone:513-636-8092
Mailing Address - Fax:513-636-9245
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:ML 5018
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3909
Practice Address - Country:US
Practice Address - Phone:513-636-8092
Practice Address - Fax:513-636-9245
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.123083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics