Healthcare Provider Details

I. General information

NPI: 1952307324
Provider Name (Legal Business Name): JENNIFER L POPOVSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER A LEVIN M.D.

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 MEDINA RD STE 100
MEDINA OH
44256-5913
US

IV. Provider business mailing address

1133 MEDINA RD STE 100
MEDINA OH
44256-5913
US

V. Phone/Fax

Practice location:
  • Phone: 330-239-4350
  • Fax: 330-239-4584
Mailing address:
  • Phone: 330-239-4350
  • Fax: 330-239-4584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number35076146 P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: