Provider Demographics
NPI:1164542122
Name:TARR, JENNIFER M (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:TARR
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 1:2500 WALES AVE., N.W.
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646
Mailing Address - Country:US
Mailing Address - Phone:330-833-8996
Mailing Address - Fax:330-833-6969
Practice Address - Street 1:2500 WALES AVE NW
Practice Address - Street 2:SUITE A
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2324
Practice Address - Country:US
Practice Address - Phone:330-833-8996
Practice Address - Fax:330-833-6969
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTA4222551OtherMEDICARE PTAN
OH2783528Medicaid
OHTA4222552OtherMEDICARE PTAN
OHTA4222551OtherMEDICARE PTAN