Healthcare Provider Details

I. General information

NPI: 1124448543
Provider Name (Legal Business Name): JENNIFER ANN MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ANN MILLS

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N MAIN ST STE 140
SPRINGBORO OH
45066-2100
US

IV. Provider business mailing address

825 N MAIN ST STE 140
SPRINGBORO OH
45066-2100
US

V. Phone/Fax

Practice location:
  • Phone: 937-762-5000
  • Fax: 937-762-5099
Mailing address:
  • Phone: 937-762-5000
  • Fax: 937-762-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0074733
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.130671
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: