Provider Demographics
NPI:1780689109
Name:ERDELYI, BOB PAUL (MD)
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:PAUL
Last Name:ERDELYI
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:400 MATTHEW ST
Practice Address - Street 2:STE 211
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1656
Practice Address - Country:US
Practice Address - Phone:740-373-6725
Practice Address - Fax:740-374-4922
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000699799OtherANTHEM
OH110194369OtherRRMCR
WV6000973000Medicaid
OH000000120129OtherANTHEM
OH2168685Medicaid
WV6000973000Medicaid
OH000000120129OtherANTHEM
H03679Medicare UPIN