Provider Demographics
NPI:1609817394
Name:ELDRIDGE, JOHN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-1600
Mailing Address - Fax:859-344-0091
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-344-1600
Practice Address - Fax:859-344-0091
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23565208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4201976OtherAETNA
OH0707088Medicaid
KY64235658Medicaid
000000747824OtherANTHEM
KY000000033738OtherANTHEM
KY3700184OtherUNITED HEALTHCARE
KY020010539OtherRAILROAD MEDICARE
0789943OtherCIGNA
KY020010539OtherRAILROAD MEDICARE
KY158870Medicare PIN
KYK036100Medicare PIN