Provider Demographics
NPI:1033288220
Name:GELFORD, KRISTA G (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:G
Last Name:GELFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N FAIRFIELD RD STE C
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2579
Mailing Address - Country:US
Mailing Address - Phone:937-427-2112
Mailing Address - Fax:937-427-2215
Practice Address - Street 1:2141 N FAIRFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-2579
Practice Address - Country:US
Practice Address - Phone:937-427-2112
Practice Address - Fax:937-427-2215
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0779484Medicaid
OH000000367149OtherANTHEM