Healthcare Provider Details

I. General information

NPI: 1518470277
Provider Name (Legal Business Name): AMY CATHERINE BRANAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9471 MARKET ST STE A
NORTH LIMA OH
44452-8702
US

IV. Provider business mailing address

9471 MARKET ST STE A
NORTH LIMA OH
44452-8702
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-7100
  • Fax: 330-758-0347
Mailing address:
  • Phone: 330-726-7100
  • Fax: 330-758-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.014262
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: