Provider Demographics
NPI:1952307324
Name:POPOVSKY, JENNIFER L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:POPOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1133 MEDINA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5913
Mailing Address - Country:US
Mailing Address - Phone:330-239-4350
Mailing Address - Fax:330-239-4584
Practice Address - Street 1:1133 MEDINA RD STE 100
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5913
Practice Address - Country:US
Practice Address - Phone:330-239-4350
Practice Address - Fax:330-239-4584
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076146 P207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH070015200OtherMEDICARE RAILROAD
OH2190785Medicaid
OH9186055OtherMEDICARE GROUP LEGACY NUM
OH9186053OtherMEDICARE GROUP LEGACY NUM
OHPO4032243Medicare PIN
OHH24383Medicare UPIN
OH2190785Medicaid