Provider Demographics
NPI:1629072517
Name:ELLIOTT, ROBERT NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEIL
Last Name:ELLIOTT
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 1:411 PLAZA DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2916
Mailing Address - Country:US
Mailing Address - Phone:812-376-5974
Mailing Address - Fax:812-375-3203
Practice Address - Street 1:2400 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201
Practice Address - Country:US
Practice Address - Phone:812-376-5974
Practice Address - Fax:812-375-3203
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056931A208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000598991OtherBCBS
IN200165460Medicaid
IN000000983472OtherANTHEM PIN
IN1396910139OtherGRP NPI
INP00732683OtherMEDICARERR
IN000000598991OtherBCBS
IN2762039Medicare PIN
IN257160BMedicare PIN