Provider Demographics
NPI:1790715217
Name:PARIKH, JEANNINE L (MD)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:L
Last Name:PARIKH
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 1:10730 MIDLAND TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-9679
Mailing Address - Country:US
Mailing Address - Phone:606-393-6193
Mailing Address - Fax:
Practice Address - Street 1:10730 MIDLAND TRAIL RD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9679
Practice Address - Country:US
Practice Address - Phone:606-393-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39307207Q00000X
OH35085814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64101652Medicaid
WV3810003782Medicaid
KYP400040919Medicaid
OH2612284Medicaid
OH4161622Medicare ID - Type Unspecified
KY3403644Medicare PIN
I03680Medicare UPIN
OH2612284Medicaid