Provider Demographics
NPI:1184691230
Name:MANDERS, JENNIFER BRYNA KATZ (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BRYNA KATZ
Last Name:MANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT, PHYS. DIV.
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-263-8622
Practice Address - Street 1:4440 RED BANK ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2172
Practice Address - Country:US
Practice Address - Phone:513-564-5000
Practice Address - Fax:513-564-4925
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0863342086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2577019Medicaid
KY64101827Medicaid
IN200521920Medicaid
KY64101827Medicaid