Provider Demographics
NPI:1962432500
Name:BRAMMELL, TIMOTHY DUANE (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DUANE
Last Name:BRAMMELL
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 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE A-510
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-258-6784
Mailing Address - Fax:859-258-6796
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE A-510
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-258-6784
Practice Address - Fax:859-258-6796
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24039208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCB5773OtherRR MEDICARE GROUP
KY64240393Medicaid
LA37903705OtherMEDICAID LAB GROUP
KY4000501OtherMEDICARE LAB GROUP
KY110245647OtherRR MEDICARE PIN
KY4000501OtherMEDICARE LAB GROUP
LA37903705OtherMEDICAID LAB GROUP