Provider Demographics
NPI:1588829360
Name:FENNIMORE, IRINA A (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:A
Last Name:FENNIMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10506 MONTGOMERY RD STE 504
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:513-221-3800
Mailing Address - Fax:513-682-4520
Practice Address - Street 1:10506 MONTGOMERY RD STE 504
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-221-3800
Practice Address - Fax:513-682-4520
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35090197207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35090197Medicaid