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General NPI Number Information
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NPI Number | 1912139072
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Entity Type | Individual
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Provider Name | BRIAN J. CARLISLE MD
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Gender | Male
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 452 W 10TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210-1240
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Country | US
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Telephone | 614-293-2957
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Fax | 614-685-6533
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Provider Business Mailing Address
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Address Line | 700 ACKERMAN RD STE 2120
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City | COLUMBUS
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State | OH
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Zip | 43202-1559
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Country | US
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Telephone | 614-293-2957
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Fax | 614-685-6533
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35096903
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 35096903
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 35096903CTR
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License Number State | OH
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