Provider Demographics
NPI:1275769614
Name:SMITH, JESSICA ANN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:SMITH
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 1:3301 MERCY HEALTH BLVD
Mailing Address - Street 2:STE. 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1105
Mailing Address - Country:US
Mailing Address - Phone:513-559-7025
Mailing Address - Fax:513-981-5755
Practice Address - Street 1:3301 MERCY HEALTH BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1105
Practice Address - Country:US
Practice Address - Phone:513-559-7025
Practice Address - Fax:513-981-5755
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35127036207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140258Medicaid
OH0140258Medicaid