Provider Demographics
NPI:1679884571
Name:FELDMAN, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FELDMAN
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 1:333 CONOVER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1900
Mailing Address - Country:US
Mailing Address - Phone:513-318-1188
Mailing Address - Fax:513-318-1189
Practice Address - Street 1:333 CONOVER DR
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1900
Practice Address - Country:US
Practice Address - Phone:513-318-1188
Practice Address - Fax:513-318-1189
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35-122020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092868Medicaid
OH35-122020OtherLICENSE