Provider Demographics
NPI:1891780920
Name:PARKINS, JACQUELINE A (DO)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:A
Last Name:PARKINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1006
Practice Address - Country:US
Practice Address - Phone:330-480-3658
Practice Address - Fax:330-480-3439
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2015-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34006750P207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2472579Medicaid
OHPA4130025Medicare Oscar/Certification
OH2472579Medicaid