Provider Demographics
NPI:1760485734
Name:DAVIDOFF, ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:DAVIDOFF
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 1:1717 W MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1347
Mailing Address - Country:US
Mailing Address - Phone:740-522-8555
Mailing Address - Fax:740-522-3620
Practice Address - Street 1:1717 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1385
Practice Address - Country:US
Practice Address - Phone:740-522-8555
Practice Address - Fax:740-522-3620
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040590207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0800066OtherUNITED HEALTHCARE
OH0333115Medicaid
OH0802942002OtherCIGNA HEALTHCARE
OH000000008372OtherANTHEM HEALTHCARE
OH648705OtherAETNA HEALTHCARE
OH791183318OtherRR MEDICARE
OH791183318OtherRR MEDICARE
OH0333115Medicaid