Provider Demographics
NPI:1114993326
Name:MOLESKI, JEANETTE ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:ANN
Last Name:MOLESKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1320 CORPORATE DR
Mailing Address - Street 2:200
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4442
Mailing Address - Country:US
Mailing Address - Phone:330-655-2668
Mailing Address - Fax:330-342-5608
Practice Address - Street 1:1320 CORPORATE DR
Practice Address - Street 2:200
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4442
Practice Address - Country:US
Practice Address - Phone:330-655-2668
Practice Address - Fax:330-342-5608
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4256-M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0677389Medicaid
OH0752376Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
OHF03915Medicare UPIN
OH9337231Medicare ID - Type UnspecifiedGROUP NUMBER