Provider Demographics
NPI:1467661314
Name:HOTHEM, ELIJAH ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:ALLEN
Last Name:HOTHEM
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 1:1481 RAYNE LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3127
Mailing Address - Country:US
Mailing Address - Phone:740-502-4752
Mailing Address - Fax:
Practice Address - Street 1:340 E TOWN ST
Practice Address - Street 2:SUITE 8900
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4600
Practice Address - Country:US
Practice Address - Phone:614-222-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.010321207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery