Provider Demographics
NPI:1497955025
Name:ELLIOTT, HEIDI LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LYNN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1110 EUCLID AVE
Practice Address - Street 2:DIVISION OF GENERAL SURGERY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1623
Practice Address - Country:US
Practice Address - Phone:216-286-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-22
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT48716208600000X
MA235499208600000X
NH14497208600000X
OH35-099767208600000X
OH099767208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068753Medicaid
MA2160641Medicaid
OH0068753Medicaid
OHH113020Medicare PIN