Provider Demographics
NPI:1841522943
Name:MARTINELLI, ELIZABETH R (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:MARTINELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ROBIN
Other - Last Name:MACIVOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-383-7660
Mailing Address - Fax:614-383-7665
Practice Address - Street 1:445 ROCKY FORK BLVD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3336
Practice Address - Country:US
Practice Address - Phone:614-383-7660
Practice Address - Fax:614-383-7665
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant