Provider Demographics
NPI:1376510917
Name:KOFFLER, ELIZABETH N (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:KOFFLER
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 1:5400 FRANTZ RD
Mailing Address - Street 2:STE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4144
Mailing Address - Country:US
Mailing Address - Phone:614-544-6155
Mailing Address - Fax:
Practice Address - Street 1:460 W CENTRAL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1435
Practice Address - Country:US
Practice Address - Phone:740-615-2700
Practice Address - Fax:740-615-2701
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-4689207V00000X
OH35.084689207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600251Medicaid
OH2600251Medicaid