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General NPI Number Information
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NPI Number | 1053407973
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Entity Type | Individual
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Provider Name | TRAESA A. BROWN MD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 400 CORPORATE CENTER DR
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City | VANDALIA
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State | OH
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Zip | 45377-1164
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Country | US
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Telephone | 937-454-5296
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Fax |
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Provider Business Mailing Address
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Address Line | 2912 SPRINGBORO W STE 201
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City | MORAINE
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State | OH
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Zip | 45439-1674
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Country | US
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Telephone | 937-297-8999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32486
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35148567
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License Number State | OH
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