MEDICARE: DR. JOLANDA M DENHAM M.D.

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	2080P0206X	Pediatric Gastroenterology Physician	35088613	OH
2	2080P0206X	Pediatric Gastroenterology Physician	ME93333	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	WH4195222	OTHER	OH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225094162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOLANDA M DENHAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 191
Second Line	:	PROVIDER ENROLLMENT DEPT
City	:	ROCKLAND
State	:	DE
Zip	:	19732-0191
Country	:	US
Telephone Number	:	302-651-6212
Fax Number	:	302-651-4945

Provider Business Practice Location Address
First Line	:	1717 S ORANGE AVE
Second Line	:	SUITE #100
City	:	ORLANDO
State	:	FL
Zip	:	32806-2944
Country	:	US
Telephone Number	:	407-650-7000
Fax Number	:	407-567-5924

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	12/17/2013

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Directions to “ DR. JOLANDA M DENHAM M.D.” Practice Location

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