MEDICARE: MARY BETH BRECKENRIDGE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	35065366	OH

General Provider Information

NPI Number	:	1164482667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH BRECKENRIDGE MD

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-293-7677
Fax Number	:	614-293-1456

Provider Business Practice Location Address
First Line	:	1800 ZOLLINGER RD FL 2
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2800
Country	:	US
Telephone Number	:	614-293-7677
Fax Number	:	614-293-1456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/21/2025

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