Provider Demographics
NPI:1801873617
Name:ELIN, RONALD J (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:ELIN
Suffix:
Gender:M
Credentials:MD, PHD
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 22214
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0214
Mailing Address - Country:US
Mailing Address - Phone:502-852-1648
Mailing Address - Fax:502-852-2046
Practice Address - Street 1:530 S JACKSON ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY & LAB MEDICINE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-4464
Practice Address - Fax:502-852-1761
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33254207ZM0300X, 207ZP0102X, 207ZP0104X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1050558OtherPASSPORT-KY MED MG CARE
KY64-332547OtherMEDICAID
IN200212190Medicaid
KYG60918Medicare UPIN
IN200212190Medicaid