Provider Demographics
NPI:1124189931
Name:FAHEY, BRIAN P (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:FAHEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-870-3669
Mailing Address - Fax:614-870-3449
Practice Address - Street 1:7811 FLINT RD STE C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-6420
Practice Address - Country:US
Practice Address - Phone:614-870-3669
Practice Address - Fax:614-870-3449
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340046752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0787304Medicaid
OH0787304Medicaid
OHH414100Medicare PIN