Provider Demographics
NPI:1407848492
Name:BITTENCE, JESSICA (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BITTENCE
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 1:10327 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-1121
Mailing Address - Country:US
Mailing Address - Phone:330-527-5430
Mailing Address - Fax:330-527-5472
Practice Address - Street 1:12689 STATE ROUTE 700
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:OH
Practice Address - Zip Code:44234-9741
Practice Address - Country:US
Practice Address - Phone:330-527-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7397811Medicare PIN
OHBI4035901Medicare PIN
BI0883059Medicare PIN
OHBI0883058Medicare PIN
OHG97861Medicare UPIN
OHBI4035902Medicare PIN