Provider Demographics
NPI:1457320434
Name:HUGHES, JEANNINE M (MD)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:M
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:MARIE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:444 N CLEVELAND AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8389
Mailing Address - Country:US
Mailing Address - Phone:614-899-2700
Mailing Address - Fax:614-823-5656
Practice Address - Street 1:444 N CLEVELAND AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8389
Practice Address - Country:US
Practice Address - Phone:614-899-2700
Practice Address - Fax:614-823-5656
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2026739Medicaid
OH2026739Medicaid
OHHU0836081Medicare ID - Type Unspecified
OH000000197171OtherANTHEM PIN NUMBER
OHG67260Medicare UPIN