Provider Demographics
NPI:1508868746
Name:MURTAGH, JENNIFER J (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:MURTAGH
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 1:2000 REGENCY COURT
Mailing Address - Street 2:STE. 103
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-475-5433
Mailing Address - Fax:419-475-4770
Practice Address - Street 1:2000 REGENCY CT
Practice Address - Street 2:STE 103
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3090
Practice Address - Country:US
Practice Address - Phone:419-475-5433
Practice Address - Fax:419-475-4770
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH07677166Medicaid
OH07677166Medicaid