Healthcare Provider Details

I. General information

NPI: 1083652838
Provider Name (Legal Business Name): BRIAN D COLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 5031 RADIOLOGY
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE ML 5031 RADIOLOGY
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4251
  • Fax: 513-636-8145
Mailing address:
  • Phone: 513-636-4251
  • Fax: 513-636-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35.066128
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number44804
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35066128
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: