Individual
DR. STACEY MARIE ELANGOVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 BURNET AVE, CINCINNATI, OH 45229-3026
(513) 636-4200
Mailing address
3333 BURNET AVE, ML5021, CINCINNATI, OH 45229
(215) 662-3264
(215) 662-2664
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
57.024996
OH
2085P0229X
Pediatric Radiology Physician
Primary
35.136498
OH
2085P0229X
Pediatric Radiology Physician
53810
KY
2085R0202X
Diagnostic Radiology Physician
MT208228
PA
Other
Enumeration date
04/24/2014
Last updated
11/06/2023
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