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NPI Code Detail

MEDICARE: STEPHANIE BROUGHTON M.D.

MEDICARE: STEPHANIE BROUGHTON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician34006667OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508811951
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE BROUGHTON M.D.
Provider Business Mailing Address
First Line : 10450 NEW HAVEN RD
Second Line :
City : HARRISON
State : OH
Zip : 45030-2780
Country : US
Telephone Number : 513-981-5852
Fax Number : 513-367-8031
Provider Business Practice Location Address
First Line : 10450 NEW HAVEN RD
Second Line :
City : HARRISON
State : OH
Zip : 45030-2780
Country : US
Telephone Number : 513-981-5852
Fax Number : 513-367-8031
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 02/26/2019

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