Provider Demographics
NPI:1780673087
Name:POWELL, JENNIFER B (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 PALOUSE DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9019
Mailing Address - Country:US
Mailing Address - Phone:740-852-6000
Mailing Address - Fax:740-852-7955
Practice Address - Street 1:54 W HIGH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1075
Practice Address - Country:US
Practice Address - Phone:740-852-6000
Practice Address - Fax:740-852-7955
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084604207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584289Medicaid
OH000000370435OtherANTHEM
OH000000370435OtherANTHEM
OHI37228Medicare UPIN