Provider Demographics
NPI:1649250374
Name:BRAMAN, KENNETH J JR (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:BRAMAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1946 TOWN PARK BLVD
Mailing Address - Street 2:#200
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8372
Mailing Address - Country:US
Mailing Address - Phone:330-896-3447
Mailing Address - Fax:330-896-9919
Practice Address - Street 1:1946 TOWN PARK BLVD
Practice Address - Street 2:#200
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8372
Practice Address - Country:US
Practice Address - Phone:330-896-3447
Practice Address - Fax:330-896-9919
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0905695Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
F41006Medicare UPIN
OH0905695Medicaid
OH0893623Medicare PIN