=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164928149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA GENE BRICKLIN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2018
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CHILDRENS PLZ
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45404-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-641-4000
-----------------------------------------------------
Fax | 937-641-4500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 933432
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44193-0039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-641-5072
-----------------------------------------------------
Fax | 937-641-6129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | MD477755
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0203X
-----------------------------------------------------
Taxonomy Name | Pediatric Critical Care Medicine Physician
-----------------------------------------------------
License Number | 35.154168
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------