MEDICARE: ROSALYND D BRACKENS 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
1	208000000X	Pediatrics Physician	128352	OH

General Provider Information

NPI Number	:	1518300029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYND D BRACKENS M.D.

Provider Business Mailing Address
First Line	:	6533 REDMONT CT
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-8755
Country	:	US
Telephone Number	:	513-336-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	7335 YANKEE RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-0006
Country	:	US
Telephone Number	:	513-336-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	11/23/2016

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