Provider Demographics
NPI:1043213739
Name:HAMILTON, JENNIFER L (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15455 MOUND BUILDERS RD
Mailing Address - Street 2:
Mailing Address - City:GLENFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43739-9703
Mailing Address - Country:US
Mailing Address - Phone:740-403-9558
Mailing Address - Fax:
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003303213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154462638OtherJENNIFER L HAMILTON, DPM, LLC NPI