Provider Demographics
NPI:1508872508
Name:BRILL, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:BRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:STE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:614-544-6382
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:500 THOMAS LN
Practice Address - Street 2:SUITE 2D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3902
Practice Address - Country:US
Practice Address - Phone:614-566-4449
Practice Address - Fax:614-533-0589
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35121923208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL050540914OtherGROUP TAX ID #
BB9802275OtherCONTROLLED SUBSTANCE
ILP00362844OtherRAILROAD PIN
IL050540914OtherGROUP TAX ID #
ILK30996/203979Medicare PIN