Provider Demographics
NPI:1902836398
Name:TILLMAN, BRYAN W (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:W
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8536
Mailing Address - Fax:614-293-8902
Practice Address - Street 1:1800 ZOLLINGER RD FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2800
Practice Address - Country:US
Practice Address - Phone:614-293-8536
Practice Address - Fax:614-293-8902
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350866112086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2987513Medicaid
NC5905537Medicaid
OH2987513Medicaid
7402831OtherAETNA
808023OtherPARTNERS
VA10387698Medicaid
NC2057248OtherMEDICARE