MEDICARE: ERIN KRISTINA IVANOFF D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2020-00538	NC
2	208M00000X	Hospitalist Physician	2020-00538	NC

General Provider Information

NPI Number	:	1598203424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN KRISTINA IVANOFF D.O.

Provider Business Mailing Address
First Line	:	15471 TRENTON RD
Second Line	:
City	:	SUNBURY
State	:	OH
Zip	:	43074-8934
Country	:	US
Telephone Number	:	614-581-4708
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 OLD VILLAGE RD
Second Line	:	DOCTORS HOSPITAL COMMUNITY MEDICINE CLINIC
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1583
Country	:	US
Telephone Number	:	614-554-1976
Fax Number	:	614-554-1981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2017
Last Update Date	:	04/27/2026

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