Provider Demographics
NPI:1700950052
Name:PELC, NANCY J (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:PELC
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 1:7871 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-1949
Mailing Address - Country:US
Mailing Address - Phone:513-319-0069
Mailing Address - Fax:
Practice Address - Street 1:7871 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-1949
Practice Address - Country:US
Practice Address - Phone:513-319-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-0006207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922809Medicaid
OHF47361Medicare UPIN
OH0922809Medicaid