Provider Demographics
NPI:1952386617
Name:ELSTON, AMANDA STORM (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:STORM
Last Name:ELSTON
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 1:860 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1800
Mailing Address - Country:US
Mailing Address - Phone:740-454-4651
Mailing Address - Fax:740-454-4653
Practice Address - Street 1:1210 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2806
Practice Address - Country:US
Practice Address - Phone:740-454-8551
Practice Address - Fax:740-454-2411
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047459E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000177592OtherUNISON PIN
OH0493360OtherUHC PIN
OH0989499OtherGROUP MEDICAID
OH000000018842OtherANTHEM PIN
OH110094948OtherMEDICARE RAILROAD
OH0564394Medicaid
OH311413469056OtherCARESOURCE PIN
OHCA0426OtherGROUP MEDICARE RAILROAD
E29768Medicare UPIN
OH000000177592OtherUNISON PIN
OHEL0642423Medicare ID - Type Unspecified