MEDICARE: JENNIFER M CARANDANG MD

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	208000000X	Pediatrics Physician	35075271	OH
2	207R00000X	Internal Medicine Physician	35075271	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00199413	OTHER	OH	RR MEDICARE
3	H544081	OTHER	OH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912909862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M CARANDANG MD

Provider Business Mailing Address
First Line	:	3755 ORANGE PL STE 101
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4455
Country	:	US
Telephone Number	:	440-455-3353
Fax Number	:	440-653-8089

Provider Business Practice Location Address
First Line	:	36711 AMERICAN WAY STE A
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-4062
Country	:	US
Telephone Number	:	440-653-8091
Fax Number	:	440-653-8089

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/06/2020

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Directions to “ JENNIFER M CARANDANG MD” Practice Location

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