Provider Demographics
NPI:1992740088
Name:PFAU, BRAD T (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:T
Last Name:PFAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:TIMOTHY
Other - Last Name:PFAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1671 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1345
Mailing Address - Country:US
Mailing Address - Phone:740-522-5437
Mailing Address - Fax:740-522-9609
Practice Address - Street 1:1671 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1345
Practice Address - Country:US
Practice Address - Phone:740-522-5437
Practice Address - Fax:740-522-9609
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.063649208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0134545OMedicaid
OH0134545OMedicaid
OH000000019409OtherANTHEM BC/BS
OH1319488OtherUNITED HEALTHCARE OF OHIO