Provider Demographics
NPI:1306880695
Name:MARANGONI, JENNIFER M (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MARANGONI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:WOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 AIRPORT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2242
Mailing Address - Country:US
Mailing Address - Phone:614-259-0910
Mailing Address - Fax:614-259-0614
Practice Address - Street 1:2600 AIRPORT DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2242
Practice Address - Country:US
Practice Address - Phone:614-259-0910
Practice Address - Fax:614-259-0614
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002379RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163294Medicaid
OHQ57753Medicare UPIN