Provider Demographics
NPI:1447408711
Name:DY, JENNIFER (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6400
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:2651 W MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4200
Practice Address - Country:US
Practice Address - Phone:330-864-4488
Practice Address - Fax:330-836-6706
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2016-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34010095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052151Medicaid
OHH017910Medicare PIN