Provider Demographics
NPI:1811096746
Name:BRILL, DAVID M (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BRILL
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 1:19324 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1802
Mailing Address - Country:US
Mailing Address - Phone:440-356-3640
Mailing Address - Fax:440-356-3729
Practice Address - Street 1:19324 DETROIT RD
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1802
Practice Address - Country:US
Practice Address - Phone:440-356-3640
Practice Address - Fax:440-356-3729
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000502409OtherANTHEM BC/BS
OH341542312147OtherCARESOURCE
OHP00705913OtherRAILROAD CARE
OH0702001Medicaid
OHP00705913OtherRAILROAD CARE
E00761Medicare UPIN
OH0702001Medicaid
OHBR0613378Medicare PIN