Healthcare Provider Details

I. General information

NPI: 1275525560
Provider Name (Legal Business Name): CREIGHTON B WRIGHT SR. MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MERCY HEALTH BLVD 5TH FLOOR
CINCINNATI OH
45211-1103
US

IV. Provider business mailing address

3300 MERCY HEALTH BLVD 5TH FLOOR
CINCINNATI OH
45211-1103
US

V. Phone/Fax

Practice location:
  • Phone: 513-215-5030
  • Fax: 513-215-5954
Mailing address:
  • Phone: 513-215-5030
  • Fax: 513-215-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number21791
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21791
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35046888W
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number21791
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35046888W
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number21791
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35046888W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: