Provider Demographics
NPI:1013128305
Name:CIANCIOLO, ELI (MD)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:CIANCIOLO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 MONTGOMERY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2280
Mailing Address - Country:US
Mailing Address - Phone:513-322-7300
Mailing Address - Fax:513-322-7307
Practice Address - Street 1:4805 MONTGOMERY RD STE 210
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2280
Practice Address - Country:US
Practice Address - Phone:513-322-7300
Practice Address - Fax:513-322-7307
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44938207LP2900X
OH35096406207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000721602OtherANTHEM
OH3001950Medicaid
KY7100201560Medicaid
OH000000721602OtherANTHEM
KYK031650Medicare PIN
OH$$$$$$$$$-00OtherOHIO BWC