Provider Demographics
NPI:1376750604
Name:DOME-LINGER, JODI (DO)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:DOME-LINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:DOME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1440
Mailing Address - Country:US
Mailing Address - Phone:740-393-9000
Mailing Address - Fax:740-392-0167
Practice Address - Street 1:1330 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1440
Practice Address - Country:US
Practice Address - Phone:740-393-9000
Practice Address - Fax:740-392-0167
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016582207R00000X
OH009735207RN0300X
OH34009735207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine