Provider Demographics
NPI:1306802616
Name:BRANE, SUJA M (MD)
Entity type:Individual
Prefix:
First Name:SUJA
Middle Name:M
Last Name:BRANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 MASON-MONTGOMERY RD.
Mailing Address - Street 2:STE. 250
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-584-6898
Mailing Address - Fax:513-584-6897
Practice Address - Street 1:9313 S MASON MONTGOMERY RD
Practice Address - Street 2:STE. 250
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8081
Practice Address - Country:US
Practice Address - Phone:513-584-6898
Practice Address - Fax:513-584-6897
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH355084078207Q00000X
KY39149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64092430Medicaid
OH2505177Medicaid
OHBR4138965Medicare PIN
I12280Medicare UPIN