Provider Demographics
NPI:1649298001
Name:MADDUX, BRIAN N (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:N
Last Name:MADDUX
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 1:4805 MONTGOMERY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2198
Mailing Address - Country:US
Mailing Address - Phone:513-961-5558
Mailing Address - Fax:513-961-1912
Practice Address - Street 1:4805 MONTGOMERY RD STE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2280
Practice Address - Country:US
Practice Address - Phone:513-241-2370
Practice Address - Fax:513-241-6053
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY419842084N0400X
OH35-0727542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01213793OtherRR MEDICARE
IN200203700Medicaid
OH2022715Medicaid
OH2442321OtherAETNA
KY7100057870Medicaid
OH000000510678OtherANTHEM
OH221373OtherUNISON
OH2442321OtherAETNA
IN200203700Medicaid
OH2022715Medicaid