Healthcare Provider Details

I. General information

NPI: 1841993664
Provider Name (Legal Business Name): BLAIR ELIZABETH CREEDLE REYNOLDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 W. 10TH AVE 774 PRIOR HALL
COLUMBUS OH
43210
US

IV. Provider business mailing address

376 W. 10TH AVE 774 PRIOR HALL
COLUMBUS OH
43210
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.155414
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: