Provider Demographics
NPI:1679747299
Name:DARGART, JAMIE L (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:DARGART
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 1:2142 N COVE BLVD
Mailing Address - Street 2:5 WEST PEDIATRICS
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3895
Mailing Address - Country:US
Mailing Address - Phone:419-291-9500
Mailing Address - Fax:419-480-6858
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:5 WEST PEDIATRICS
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-9500
Practice Address - Fax:419-480-6858
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119993208000000X
OH350980522080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0054805Medicaid
OH0054805Medicaid