Provider Demographics
NPI:1497885933
Name:JEAN-PIERRE, VERONICA ALICIA (MD)
Entity Type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:ALICIA
Last Name:JEAN-PIERRE
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 1:2630 ELM RD NE BLDG C
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9393
Mailing Address - Country:US
Mailing Address - Phone:330-841-3010
Mailing Address - Fax:
Practice Address - Street 1:2630 ELM RD NE BLDG C
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9393
Practice Address - Country:US
Practice Address - Phone:330-841-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1165174400000X, 207RE0101X
OH35094990207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177167701Medicaid
OH3062359Medicaid
MI1497885933Medicaid
TX177167701Medicaid
TXI04631Medicare UPIN
TX8F0756Medicare PIN