Provider Demographics
NPI:1629367867
Name:SOPKOVICH, JENNIFER ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:SOPKOVICH
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-1707
Mailing Address - Fax:614-293-1716
Practice Address - Street 1:540 OFFICENTER PL
Practice Address - Street 2:SUITE 240
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5317
Practice Address - Country:US
Practice Address - Phone:614-293-1707
Practice Address - Fax:614-293-1716
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35122127207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology