Provider Demographics
NPI:1427082551
Name:FATH, JENNIFER M (DPM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:FATH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:1221 S WATER STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3843
Mailing Address - Country:US
Mailing Address - Phone:330-474-0500
Mailing Address - Fax:330-474-0501
Practice Address - Street 1:1221 S. WATER STREET
Practice Address - Street 2:SUITE A
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240
Practice Address - Country:US
Practice Address - Phone:330-474-0500
Practice Address - Fax:330-474-0501
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH36003277F213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427082551OtherNPI
OH2361484Medicaid
OH36003277FOtherOHIO
OH4084532Medicare ID - Type Unspecified
OH2361484Medicaid
1427082551OtherNPI