Healthcare Provider Details

I. General information

NPI: 1700397825
Provider Name (Legal Business Name): BRYN THATCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 07/30/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1 WYOMING ST. ATTN: PAM SHANK
DAYTON OH
45409
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3882
  • Fax:
Mailing address:
  • Phone: 937-208-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11022510A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.1300114
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number57.259516
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.259516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: