Provider Demographics
NPI:1508228776
Name:ENGEL, ELISSA ROSE (MD)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:ROSE
Last Name:ENGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 11009
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-0278
Mailing Address - Fax:513-636-7951
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 11009
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-0278
Practice Address - Fax:513-636-7951
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.139293208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLH984OtherMEDICARE
FL6WXGPOtherBLUE CROSS BLUE SHIELD
FL103295300Medicaid