Provider Demographics
NPI:1881633386
Name:BRAMMER, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BRAMMER
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 1:2350 MIAMI VALLEY DR
Mailing Address - Street 2:SUITE 530
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4778
Mailing Address - Country:US
Mailing Address - Phone:937-435-3546
Mailing Address - Fax:937-435-3568
Practice Address - Street 1:2350 MIAMI VALLEY DRIVE
Practice Address - Street 2:SUITE 530
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2786
Practice Address - Country:US
Practice Address - Phone:937-435-3546
Practice Address - Fax:937-435-3568
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.052489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0260131Medicaid
OH0635194Medicare PIN
E29564Medicare UPIN
OH0635193Medicare PIN