Provider Demographics
NPI:1629042361
Name:BRABENDER, WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:BRABENDER
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:PO BOX 636461
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6461
Mailing Address - Country:US
Mailing Address - Phone:440-988-1009
Mailing Address - Fax:440-988-1225
Practice Address - Street 1:578 N LEAVITT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1131
Practice Address - Country:US
Practice Address - Phone:440-988-5226
Practice Address - Fax:440-988-5645
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0522714Medicaid
OH0236248Medicaid
OH0623212Medicare ID - Type Unspecified
A17662Medicare UPIN
OH0522714Medicaid
OH9284951Medicare PIN