Healthcare Provider Details

I. General information

NPI: 1659570448
Provider Name (Legal Business Name): ANETA J HOMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANETA JEDRZEJCZYK MD

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/07/2021
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SOUTH AVE STE 2
BOARDMAN OH
44512-3644
US

IV. Provider business mailing address

7000 SOUTH AVE STE 2
BOARDMAN OH
44512-3644
US

V. Phone/Fax

Practice location:
  • Phone: 330-314-9140
  • Fax: 330-259-9721
Mailing address:
  • Phone: 330-314-9140
  • Fax: 330-259-9721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.092671
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: