Provider Demographics
NPI:1629385737
Name:DR JENIFER R LLOYD LLC
Entity Type:Organization
Organization Name:DR JENIFER R LLOYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-758-9189
Mailing Address - Street 1:8060 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6241
Mailing Address - Country:US
Mailing Address - Phone:330-758-9189
Mailing Address - Fax:330-758-4487
Practice Address - Street 1:8060 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6241
Practice Address - Country:US
Practice Address - Phone:330-758-9189
Practice Address - Fax:330-758-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004266207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE93269Medicare UPIN
OH0696181Medicare PIN