Healthcare Provider Details

I. General information

NPI: 1023094638
Provider Name (Legal Business Name): JENNIFER ANN MARGOLIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN SMITH M.D.

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CRESCENT AVE UNIVERSITY WYOMING FAMILY PRACTICE CENTER
CINCINNATI OH
45215-4406
US

IV. Provider business mailing address

2830 VICTORY PKWY STE 120
CINCINNATI OH
45206-1786
US

V. Phone/Fax

Practice location:
  • Phone: 513-821-0275
  • Fax: 513-821-3621
Mailing address:
  • Phone: 513-245-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.040619
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: