Provider Demographics
NPI:1528449824
Name:EVERETT, ELYSE AUFMAN (MD)
Entity type:Individual
Prefix:DR
First Name:ELYSE
Middle Name:AUFMAN
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:L
Other - Last Name:AUFMAN
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:614-293-4969
Mailing Address - Fax:614-293-6111
Practice Address - Street 1:2050 KENNY RD FL 3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-4969
Practice Address - Fax:614-293-6111
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019015701207R00000X, 207RH0002X, 2084N0400X
OH35.1498982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200061620Medicaid