Provider Demographics
NPI:1255497533
Name:CRELLIN, BRIAN K (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:CRELLIN
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 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-7650
Mailing Address - Fax:513-246-2391
Practice Address - Street 1:8311 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2227
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-246-2397
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009040207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2766261Medicaid
OH000000535247OtherANTHEM
OH2812625OtherUNITED HEALTHCARE
OH2812625OtherUNITED HEALTHCARE
OHCR4206131Medicare PIN
OH2766261Medicaid