Provider Demographics
NPI:1972557932
Name:BRANAM, CHRISTOPHER O (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:O
Last Name:BRANAM
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 1:1540 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9501
Mailing Address - Country:US
Mailing Address - Phone:304-429-6741
Mailing Address - Fax:304-429-7522
Practice Address - Street 1:1540 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9501
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:304-429-7522
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-7214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
001719574OtherMOUNTAIN STATE BCBS
WV0054153000Medicaid
OH000000181580OtherUNISON MEDICAID
000000476933OtherANTHEM BCBS
1972557932OtherNPI
OH0995286Medicaid
OH310917085164OtherCARESOURCE MEDICAID
P00286536OtherRR MEDICARE
OH0995286OtherMOLINA MEDICAID
OH0771394Medicare PIN
OH000000181580OtherUNISON MEDICAID
1972557932OtherNPI