Provider Demographics
NPI:1538137724
Name:TALLERICO, BRIAN DAVID (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:TALLERICO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:17 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-567-0455
Mailing Address - Fax:315-253-1795
Practice Address - Street 1:986 WELLNESS WAY STE 300
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7353
Practice Address - Country:US
Practice Address - Phone:803-930-9401
Practice Address - Fax:803-462-4847
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036144262207X00000X
WY7324A207X00000X
NY295000207X00000X
SC89674207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery