Provider Demographics
NPI:1386865087
Name:ABOWD, JEMMA SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:JEMMA
Middle Name:SUZANNE
Last Name:ABOWD
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 1:580 CRAIG DR STE 8
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1776
Mailing Address - Country:US
Mailing Address - Phone:419-861-5430
Mailing Address - Fax:
Practice Address - Street 1:580 CRAIG DR STE 8
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1776
Practice Address - Country:US
Practice Address - Phone:419-861-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000523100OtherANTHEM
OH000000699384OtherANTHEM
OH7931579OtherAETNA
OH2780914Medicaid
MI5189373Medicaid
OHP00912444OtherRRMC
OHP00418382OtherRAILROAD MEDICARE
MI5189373Medicaid
OH000000523100OtherANTHEM
I11214Medicare UPIN