Healthcare Provider Details

I. General information

NPI: 1083768154
Provider Name (Legal Business Name): L CANDACE JENNINGS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 W DUBLIN GRANVILLE RD
DUBLIN OH
43017-1436
US

IV. Provider business mailing address

453 W 10TH AVE
COLUMBUS OH
43210-2205
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2957
  • Fax: 614-688-3700
Mailing address:
  • Phone: 614-293-2957
  • Fax: 614-688-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number59514
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number35.120973
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: