Provider Demographics
NPI:1790787786
Name:LAGER-FERMON, JENNIFER (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LAGER-FERMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SMITH RD
Mailing Address - Street 2:STE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-533-6000
Practice Address - Street 1:7423 S MASON MONTGOMERY RD
Practice Address - Street 2:SUITE B
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7828
Practice Address - Country:US
Practice Address - Phone:513-398-3445
Practice Address - Fax:513-398-4680
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2534225Medicaid
OHH251130Medicare PIN
OHLA4151022Medicare PIN
OH2534225Medicaid