Healthcare Provider Details

I. General information

NPI: 1275732216
Provider Name (Legal Business Name): JENNIFER JEANETTE LADD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JEANETTE LADD D.O.

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 DONNALLY ST STE 203
CHARLESTON WV
25301-1600
US

IV. Provider business mailing address

4605 MACCORKLE AVE SW THS PHYSICIAN PARTNERS, INC-ADMIN OFFICE
SOUTH CHARLESTON WV
25309-1311
US

V. Phone/Fax

Practice location:
  • Phone: 304-347-6700
  • Fax: 304-347-6841
Mailing address:
  • Phone: 304-414-4800
  • Fax: 304-414-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2325
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: