Provider Demographics
NPI:1811091341
Name:POINDEXTER, BRENDA (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:LOUISE BRADLEY
Other - Last Name:POINDEXTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:3333 BURNET AVE. ML 7009
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4830
Mailing Address - Fax:513-636-7868
Practice Address - Street 1:3333 BURNET AVE. ML 7009
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4830
Practice Address - Fax:513-636-7868
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA851612080N0001X
OH35.0625802080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200144470Medicaid
IN200144470Medicaid
G51613Medicare UPIN