Healthcare Provider Details

I. General information

NPI: 1912909862
Provider Name (Legal Business Name): JENNIFER M CARANDANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36711 AMERICAN WAY STE A
AVON OH
44011-4062
US

IV. Provider business mailing address

3755 ORANGE PL STE 101
BEACHWOOD OH
44122-4455
US

V. Phone/Fax

Practice location:
  • Phone: 440-653-8091
  • Fax: 440-653-8089
Mailing address:
  • Phone: 440-455-3353
  • Fax: 440-653-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35075271
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35075271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: