Provider Demographics
NPI:1598203424
Name:IVANOFF, ERIN KRISTINA (DO)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:KRISTINA
Last Name:IVANOFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15471 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-8934
Mailing Address - Country:US
Mailing Address - Phone:614-581-4708
Mailing Address - Fax:
Practice Address - Street 1:50 OLD VILLAGE RD
Practice Address - Street 2:DOCTORS HOSPITAL COMMUNITY MEDICINE CLINIC
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1583
Practice Address - Country:US
Practice Address - Phone:614-554-1976
Practice Address - Fax:614-554-1981
Is Sole Proprietor?:No
Enumeration Date:2017-02-12
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-00538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine