Provider Demographics
NPI:1396735650
Name:SKALE, BRIAN T (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:SKALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-206-1320
Mailing Address - Fax:513-232-8483
Practice Address - Street 1:7545 BEECHMONT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4222
Practice Address - Country:US
Practice Address - Phone:513-206-1320
Practice Address - Fax:513-232-8483
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-050282174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00367109OtherRAILROAD MEDICARE
OH0582516Medicaid
OHSK0554111Medicare PIN
OHSK0554115Medicare PIN
OHP00367109OtherRAILROAD MEDICARE
OHA15863Medicare UPIN
OH0582516Medicaid