Provider Demographics
NPI:1164480851
Name:EBOH, NOEL N (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:N
Last Name:EBOH
Suffix:
Gender:M
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:# L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43301-1814
Practice Address - Country:US
Practice Address - Phone:740-383-7950
Practice Address - Fax:740-383-7087
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044038E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0410657Medicaid
140004259OtherTRAVELERS MEDICARE
311098079OtherPPO NEXT
0465301OtherPALMETTO MEDICARE
353077OtherSUBMITTER NO
311098079069OtherCIGNA
0600018OtherUHC
311098079OtherTAX ID
311098079OtherTAXID E
646717OtherAETNA
OH000000118446OtherANTHEM
311098079OtherTAX ID PHYSICIANS NONPHYS
353077OtherSUBMITTER NO
A78889Medicare UPIN
0465301OtherPALMETTO MEDICARE