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General NPI Number Information
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NPI Number | 1336102037
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Entity Type | Individual
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Provider Name | JILL C HERTZENDORF MD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 420 N JAMES RD
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City | COLUMBUS
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State | OH
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Zip | 43219-1834
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Country | US
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Telephone | 614-257-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 420 N JAMES RD
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City | COLUMBUS
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State | OH
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Zip | 43219-1834
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Country | US
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Telephone | 614-257-5200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 35.056454
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License Number State | OH
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