Provider Demographics
NPI:1679269252
Name:STAVROFF, ERIN (DO)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:STAVROFF
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 1:751 S LAZELLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2017
Mailing Address - Country:US
Mailing Address - Phone:614-565-1109
Mailing Address - Fax:
Practice Address - Street 1:4439 STATE ROUTE 159 STE 150
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7833
Practice Address - Country:US
Practice Address - Phone:740-779-7070
Practice Address - Fax:740-779-8449
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.033729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine