Provider Demographics
NPI:1932306479
Name:PARTIN, JESSICA (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PARTIN
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 1:3 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4955
Mailing Address - Country:US
Mailing Address - Phone:540-224-5170
Mailing Address - Fax:540-983-8212
Practice Address - Street 1:3 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4955
Practice Address - Country:US
Practice Address - Phone:540-224-5170
Practice Address - Fax:540-983-8212
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-095761208600000X
WV225742086X0206X
VA0101261647208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3076497Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE #
OH1225212707OtherAKRON BREAST SURGEONS TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID #
WV3810026956Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP NPI #
OH3076497Medicaid
OH1841239274OtherPARTNERS PHYSICIAN GROUP NPI #