Provider Demographics
NPI:1720065576
Name:ASHWORTH, JEANNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:L
Last Name:ASHWORTH
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 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 CRESCENT HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6406
Practice Address - Country:US
Practice Address - Phone:740-387-6722
Practice Address - Fax:740-387-2275
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350766952085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161954OtherUNITED HEALTHCARE
OH000000365107OtherANTHEM BCBS
OH275523802006OtherMEDICAL MUTUAL
OH2160530Medicaid
OH2160530Medicaid
OHG21787Medicare UPIN
OHP00210198Medicare ID - Type UnspecifiedRAILROAD MEDICARE