Healthcare Provider Details

I. General information

NPI: 1740255546
Provider Name (Legal Business Name): JILL C MANAHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7567 CENTRAL PARKE BLVD STE C
MASON OH
45040-6855
US

IV. Provider business mailing address

7567 CENTRAL PARKE BLVD STE C
MASON OH
45040-6855
US

V. Phone/Fax

Practice location:
  • Phone: 513-995-7185
  • Fax: 844-751-3561
Mailing address:
  • Phone: 513-995-7185
  • Fax: 844-751-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008059M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: