Provider Demographics
NPI:1598056376
Name:DEMOS-BERTRAND, JENNIFER (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DEMOS-BERTRAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DEMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT, PHYS DIV
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:6939 COX RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-567-1600
Practice Address - Fax:513-564-1624
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03870207V00000X
OH34.011837207V00000X
KYTP424207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK150760Medicare PIN