Provider Demographics
NPI:1043314685
Name:JOLLIFF, AMY S (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:JOLLIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E MILLTOWN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691
Mailing Address - Country:US
Mailing Address - Phone:330-345-8060
Mailing Address - Fax:330-345-5983
Practice Address - Street 1:128 E MILLTOWN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691
Practice Address - Country:US
Practice Address - Phone:330-345-8060
Practice Address - Fax:330-345-5983
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35058875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9304461OtherMEDICARE GROUP
2123062OtherMEDICAID GROUP
OH0835967Medicaid
9304461OtherMEDICARE GROUP
E88369Medicare UPIN