Provider Demographics
NPI:1083841357
Name:JALLOH, ZENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ZENA
Middle Name:
Last Name:JALLOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MCKINLEY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6399
Mailing Address - Country:US
Mailing Address - Phone:740-383-8700
Mailing Address - Fax:937-619-4150
Practice Address - Street 1:4750 HEMPSTEAD STATION DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5164
Practice Address - Country:US
Practice Address - Phone:800-875-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-120073207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program