Provider Demographics
NPI:1154676948
Name:WATSON, JENNIFER MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1946 TOWN PARK BLVD
Mailing Address - Street 2:#200
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8372
Mailing Address - Country:US
Mailing Address - Phone:330-896-3447
Mailing Address - Fax:330-896-9919
Practice Address - Street 1:1946 TOWN PARK BLVD
Practice Address - Street 2:#200
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8372
Practice Address - Country:US
Practice Address - Phone:330-896-3447
Practice Address - Fax:330-896-9919
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-125670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0124319Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1821035940OtherAKRON GENERAL MEDICAL CENTER TYPE 2 NPI #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH0454744OtherAKRON GENERAL MEDICAL CENTER MEDICAID GROUP # (IMCA)
OH36000271OtherAKRON GENERAL MEDICAL CENTER MEDICARE GROUP # (IMCA)
OHH375630Medicare PIN