Provider Demographics
NPI:1396891099
Name:BRIAN S. GREGORI, DO INC
Entity type:Organization
Organization Name:BRIAN S. GREGORI, DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREGORI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-884-4596
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-6554
Mailing Address - Country:US
Mailing Address - Phone:614-864-9560
Mailing Address - Fax:614-864-9709
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-884-4596
Practice Address - Fax:614-884-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005582G207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBRSP01901Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #