Provider Demographics
NPI:1306807185
Name:RAWLINS, JENNIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:RAWLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BARGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331
Mailing Address - Country:US
Mailing Address - Phone:937-548-3806
Mailing Address - Fax:937-548-3552
Practice Address - Street 1:10484 KLEY RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:OH
Practice Address - Zip Code:45380-9561
Practice Address - Country:US
Practice Address - Phone:937-526-3016
Practice Address - Fax:937-526-3809
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081029R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2338223Medicaid
OHRA4089871Medicare ID - Type Unspecified
OH2338223Medicaid