Healthcare Provider Details

I. General information

NPI: 1467912055
Provider Name (Legal Business Name): ABIGAIL BRACKEN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 LUCILLE DR
CINCINNATI OH
45213-2674
US

IV. Provider business mailing address

3590 LUCILLE DR
CINCINNATI OH
45213-2674
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8400
  • Fax: 513-475-8228
Mailing address:
  • Phone: 513-475-8400
  • Fax: 513-475-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.154628
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number35.154628
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: