Provider Demographics
NPI:1811334147
Name:JERGOVICH, BRITTNEY (DO)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:JERGOVICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 ROSEMONT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4569
Mailing Address - Country:US
Mailing Address - Phone:330-626-5566
Mailing Address - Fax:330-626-2042
Practice Address - Street 1:9480 ROSEMONT DR STE 100
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4569
Practice Address - Country:US
Practice Address - Phone:330-626-5566
Practice Address - Fax:330-626-2042
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013372207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program