Provider Demographics
NPI:1801899927
Name:ELCONIN, JOEL H (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:H
Last Name:ELCONIN
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 1:41201 SCHADDEN RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2249
Mailing Address - Country:US
Mailing Address - Phone:440-324-0400
Mailing Address - Fax:440-324-0441
Practice Address - Street 1:41201 SCHADDEN RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2249
Practice Address - Country:US
Practice Address - Phone:440-324-0400
Practice Address - Fax:440-324-0441
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-1802085R0001X
OH35.0977672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB3514Medicaid
H24231Medicare UPIN
NMB3514Medicaid