MEDICARE: INGA JOLLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34-00-7075-J	OH

General Provider Information

NPI Number	:	1639117674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGA JOLLY

Provider Business Mailing Address
First Line	:	PO BOX 951603
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 N HIGH ST
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-8532
Country	:	US
Telephone Number	:	614-627-1878
Fax Number	:	614-855-4813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/24/2019

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Directions to “ INGA JOLLY ” Practice Location

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