Provider Demographics
NPI:1154504868
Name:JEFFERIS, MELISSA (MD)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:JEFFERIS
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 1:697 THOMAS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3931
Mailing Address - Country:US
Mailing Address - Phone:614-566-5414
Mailing Address - Fax:614-566-6843
Practice Address - Street 1:697 THOMAS LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3931
Practice Address - Country:US
Practice Address - Phone:614-566-5414
Practice Address - Fax:614-566-6843
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57-013690207Q00000X
OH35-092797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2899743Medicaid
OH2899743Medicaid