Healthcare Provider Details

I. General information

NPI: 1841591757
Provider Name (Legal Business Name): BRIAN ABBOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8305
  • Fax:
Mailing address:
  • Phone: 505-923-6670
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57.017737
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: