Provider Demographics
NPI:1154784627
Name:OLDS, ELIZABETH FRANCES MARIE
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:FRANCES MARIE
Last Name:OLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 BENEDICT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2712
Mailing Address - Country:US
Mailing Address - Phone:419-668-9409
Mailing Address - Fax:419-668-7099
Practice Address - Street 1:282 BENEDICT AVE STE B
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2712
Practice Address - Country:US
Practice Address - Phone:419-668-9409
Practice Address - Fax:419-668-7099
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0357749Medicaid