Basic Information
| Provider Information | |||||||||
| NPI: | 1396746301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRICKING | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4415 AICHOLTZ RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452451506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137529610 | ||||||||
| FaxNumber: | 5137328734 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 MERCY HEALTH PL | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452376147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139525930 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 37143 | KY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 35070974 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64942956 | 05 | KY | MEDICAID | 2034908 | 05 | OH | MEDICAID |