Healthcare Provider Details

I. General information

NPI: 1780647560
Provider Name (Legal Business Name): ERIC VICTOR JELINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 TIQUA TRAIL
LIMA OH
45805-4705
US

IV. Provider business mailing address

1250 S WASHINGTON ST
VAN WERT OH
45891-2551
US

V. Phone/Fax

Practice location:
  • Phone: 419-999-5353
  • Fax: 866-898-2159
Mailing address:
  • Phone: 419-232-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35061496
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000028205
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM
# 2
Identifier0855632
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 3
IdentifierJE0717158
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerMEDICARE ID FSH RAD GRP
# 4
IdentifierJE0717158
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerMEDICARE OHIO ID
# 5
Identifier300071733
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: