Provider Demographics
NPI:1588606669
Name:HAMPTON-MONTAVON, JENNIFER R (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:HAMPTON-MONTAVON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1012 EAST CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342
Mailing Address - Country:US
Mailing Address - Phone:937-866-0741
Mailing Address - Fax:937-866-8861
Practice Address - Street 1:1012 EAST CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342
Practice Address - Country:US
Practice Address - Phone:937-866-0741
Practice Address - Fax:937-866-8861
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07496700207Q00000X
PAOS013106207Q00000X
DEC20007383207Q00000X
OH009511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I19380Medicare UPIN