Provider Demographics
NPI:1912909862
Name:CARANDANG, JENNIFER M (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:CARANDANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 ORANGE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4455
Mailing Address - Country:US
Mailing Address - Phone:440-455-3353
Mailing Address - Fax:440-653-8089
Practice Address - Street 1:36711 AMERICAN WAY STE A
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-4062
Practice Address - Country:US
Practice Address - Phone:440-653-8091
Practice Address - Fax:440-653-8089
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075271208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2260771Medicaid
OHP00199413OtherRR MEDICARE
OHH544081OtherMEDICARE
OH4056488Medicare PIN
OHH544081OtherMEDICARE
OH4056482Medicare PIN