Provider Demographics
NPI:1275732216
Name:LADD, JENNIFER JEANETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JEANETTE
Last Name:LADD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:JEANETTE
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:THS PHYSICIAN PARTNERS, INC-ADMIN OFFICE
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:304-414-4801
Practice Address - Street 1:500 DONNALLY ST STE 203
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1600
Practice Address - Country:US
Practice Address - Phone:304-347-6700
Practice Address - Fax:304-347-6841
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023157Medicaid
WVB441OtherGROUP MEDICARE
WV3810024049OtherGROUP MEDICAID
WV3810024049OtherGROUP MEDICAID