Basic Information
| Provider Information | |||||||||
| NPI: | 1205839503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSACCO | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2060 READING RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137213200 | ||||||||
| FaxNumber: | 5136393186 | ||||||||
| Practice Location | |||||||||
| Address1: | 7495 STATE RD | ||||||||
| Address2: | STE 325 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452556404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132332000 | ||||||||
| FaxNumber: | 5136242684 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35048242B | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 287923 | 01 | OH | AMERIGROUP | OTHER | 0511655 | 05 | OH | MEDICAID | 0720620 | 01 | OH | UNITED HEALTHCARE | OTHER | 1023323 | 01 | OH | AETNA | OTHER | 31157505103 | 01 | OH | CARESOURCE | OTHER | 000000020974 | 01 | OH | ANTHEM | OTHER |