Provider Demographics
NPI:1336107366
Name:RICHARD, JENNIFER BLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BLAIR
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6859 OBANNON BLF
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6018
Mailing Address - Country:US
Mailing Address - Phone:513-683-1568
Mailing Address - Fax:513-752-3387
Practice Address - Street 1:4371 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1668
Practice Address - Country:US
Practice Address - Phone:513-752-3650
Practice Address - Fax:513-752-3387
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics