Provider Demographics
NPI:1760477087
Name:KELMAN, JAY P (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:P
Last Name:KELMAN
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 1:1945 CEI DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5664
Mailing Address - Country:US
Mailing Address - Phone:513-984-5133
Mailing Address - Fax:
Practice Address - Street 1:1945 CEI DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5664
Practice Address - Country:US
Practice Address - Phone:513-984-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.039665207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0326409Medicaid
IN200857170Medicaid
KY7100003830Medicaid
OH000000522337OtherANTHEM
IN200857170Medicaid
IN200857170Medicaid
OH000000522337OtherANTHEM