Individual
SUSAN E. BRALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
234 GOODMAN ST, ML 0761, CINCINNATI, OH 45267-1000
(513) 584-4391
(513) 584-0431
Mailing address
PO BOX 636256 CENTRAL CREDENTIALING, CINCINNATI, OH 45263-6256
(513) 245-3107
(513) 585-5511
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35-06-2155
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000013880
ANTHEM
OH
05
—
0843798
—
OH
01
—
1620954
UNITED HEALTHCARE
OH
05
—
200039480A
—
IN
05
—
64868219
—
KY
01
—
655258
AETNA
OH
Enumeration date
10/17/2005
Last updated
02/12/2018
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