Provider Demographics
NPI:1114970217
Name:O'DELL, NANCY ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:ELAINE
Last Name:O'DELL
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 1:2261 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4459
Mailing Address - Country:US
Mailing Address - Phone:330-543-8823
Mailing Address - Fax:330-296-6535
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8823
Practice Address - Fax:330-296-6535
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-080465207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000213666OtherANTHEM PROVIDER
OH2064439Medicaid
OH2064439Medicaid
OHOD4067111Medicare ID - Type Unspecified