Healthcare Provider Details

I. General information

NPI: 1932192515
Provider Name (Legal Business Name): JENNIFER M RIDGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N BREIEL BLVD
MIDDLETOWN OH
45042-3808
US

IV. Provider business mailing address

1 GARDNER PL
MIDDLETOWN OH
45042-2338
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-7231
  • Fax: 513-424-1770
Mailing address:
  • Phone: 513-727-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35060180
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number35.060180
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number35.060180
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.060180
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: