Healthcare Provider Details

I. General information

NPI: 1851377246
Provider Name (Legal Business Name): JENNIFER R WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4885 OLENTANGY RIVER RD SUITE 2-10
COLUMBUS OH
43214-1926
US

IV. Provider business mailing address

4885 OLENTANGY RIVER RD SUITE 2-10
COLUMBUS OH
43214-1926
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-7878
  • Fax: 614-267-7077
Mailing address:
  • Phone: 614-267-7878
  • Fax: 614-267-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-05-5441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: