Provider Demographics
NPI:1972563104
Name:SCHWEITZER-AHMED, JENNIFER A (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SCHWEITZER-AHMED
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 1:124 WEST MAIN ST
Mailing Address - Street 2:P O BOX 399
Mailing Address - City:FAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43521
Mailing Address - Country:US
Mailing Address - Phone:419-237-2501
Mailing Address - Fax:419-237-2671
Practice Address - Street 1:124 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43521
Practice Address - Country:US
Practice Address - Phone:419-237-2501
Practice Address - Fax:419-237-2671
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000491881OtherANTHEM
OH06376OtherPHC
OH0168929Medicaid
OH4662331OtherAETNA
OHGO8798Medicare UPIN
OH0168929Medicaid