Provider Demographics
NPI:1730236837
Name:MCKELVEY, ERIN JEANINE (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:JEANINE
Last Name:MCKELVEY
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 1:970 E WASHINGTON ST
Mailing Address - Street 2:SUITE 5F
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-725-5282
Mailing Address - Fax:330-725-2244
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:SUITE 5F
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-725-5282
Practice Address - Fax:330-725-2244
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073027207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2193871Medicaid
4028071Medicare ID - Type Unspecified
H20283Medicare UPIN