Healthcare Provider Details

I. General information

NPI: 1396901534
Provider Name (Legal Business Name): JENNIFER L PICARSIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L MILLER MD

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 1035
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4261
  • Fax: 513-636-3924
Mailing address:
  • Phone: 513-636-4261
  • Fax: 513-636-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD441545
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number35.137190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: