Provider Demographics
NPI:1528059482
Name:REGAN, JODI K (MD)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:K
Last Name:REGAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 PRESTIGE PL STE 550
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8068
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-4500
Practice Address - Fax:330-543-4508
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-10-25
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Provider Licenses
StateLicense IDTaxonomies
KY32721207V00000X
NV18609207V00000X
MN42051207V00000X
OH35071890207VM0101X, 207VX0201X
AZ53060207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0094056Medicaid
123745OtherU CARE
2116603OtherFIRST HEALTH PLAN
0712622OtherMEDICA HEALTH PLANS
1021488OtherPREFERRED ONE
HP29389OtherHEALTH PARTNERS
AZ277278Medicaid
287818600OtherMEDICAL ASSISTANCE
71D48REOtherBLUE CROSS BLUE SHIELD
854750OtherARAZ GRP AMERICA'S PPO
OH0094056Medicaid
AZ277278Medicaid