Provider Demographics
NPI:1356578710
Name:BOCKBRADER, MARCIA AILEEN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:AILEEN
Last Name:BOCKBRADER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:6565 S SECTION LINE RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7961
Mailing Address - Country:US
Mailing Address - Phone:614-286-0305
Mailing Address - Fax:614-482-4938
Practice Address - Street 1:2929 KENNY RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2415
Practice Address - Country:US
Practice Address - Phone:614-670-4000
Practice Address - Fax:614-482-4938
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
1744R1102X, 246ZE0500X, 390200000X
OH351201182081P0301X, 2083A0300X, 208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No1744R1102XOther Service ProvidersSpecialistResearch Study
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGMedicare PIN