Provider Demographics
NPI:1780647560
Name:JELINGER, ERIC V (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:V
Last Name:JELINGER
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 1:1250 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2551
Mailing Address - Country:US
Mailing Address - Phone:419-232-5279
Mailing Address - Fax:
Practice Address - Street 1:850 TIQUA TRAIL
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-4705
Practice Address - Country:US
Practice Address - Phone:419-999-5353
Practice Address - Fax:866-898-2159
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350614962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000028205OtherANTHEM
OH0855632Medicaid
OHJE0717158OtherMEDICARE ID FSH RAD GRP
OHJE0717158OtherMEDICARE OHIO ID
OH300071733OtherRAILROAD MEDICARE
OHJE0717158OtherMEDICARE OHIO ID
OHJE7019792Medicare ID - Type Unspecified
OHJE7019791Medicare PIN