Healthcare Provider Details

I. General information

NPI: 1891801148
Provider Name (Legal Business Name): MATTHEW S JENNINGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6270 NORTH RIDGE ROAD
MADISON OH
44057
US

IV. Provider business mailing address

PO BOX 714328
COLUMBUS OH
43271-4328
US

V. Phone/Fax

Practice location:
  • Phone: 440-428-6225
  • Fax: 440-428-8226
Mailing address:
  • Phone: 800-354-1985
  • Fax: 440-350-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-081271
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: