Provider Demographics
NPI:1295710465
Name:THARP, JEFFREY S (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:THARP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6847 N CHESTNUT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3929
Mailing Address - Country:US
Mailing Address - Phone:330-297-6030
Mailing Address - Fax:330-297-4919
Practice Address - Street 1:6847 N CHESTNUT ST STE 105
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-297-6030
Practice Address - Fax:330-974-9192
Is Sole Proprietor?:No
Enumeration Date:2005-12-10
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005397207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237121Medicaid
G08084Medicare UPIN
4197014Medicare PIN
P00357357Medicare PIN