MEDICARE: DR. JEFFREY W CRECELIUS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	35057106	OH

General Provider Information

NPI Number	:	1043217466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY W CRECELIUS MD

Provider Business Mailing Address
First Line	:	3855 TRUEMAN CT
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-2496
Country	:	US
Telephone Number	:	614-777-1800
Fax Number	:	614-777-1831

Provider Business Practice Location Address
First Line	:	3855 TRUEMAN CT
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-2496
Country	:	US
Telephone Number	:	614-777-1800
Fax Number	:	614-777-1831

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/06/2015

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