Provider Demographics
NPI:1508956830
Name:WOJTOWICZ, JENNIFER A (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:WOJTOWICZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SEASONS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44224
Mailing Address - Country:US
Mailing Address - Phone:330-650-5110
Mailing Address - Fax:330-650-5115
Practice Address - Street 1:231 SEASONS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44224
Practice Address - Country:US
Practice Address - Phone:330-650-5110
Practice Address - Fax:330-650-5115
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006917207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2423514Medicaid
4109793Medicare PIN
OHH87907Medicare UPIN