1932306479 NPI number — JESSICA PARTIN M.D.

Table of content: JESSICA PARTIN M.D. (NPI 1932306479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932306479 NPI number — JESSICA PARTIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARTIN
Provider First Name:
JESSICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932306479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 RIVERSIDE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24016-4955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-224-5170
Provider Business Mailing Address Fax Number:
540-983-8212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 RIVERSIDE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24016-4955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-224-5170
Provider Business Practice Location Address Fax Number:
540-983-8212
Provider Enumeration Date:
06/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  35-095761 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: 22574 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 0101261647 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3076497 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9338635 . This is a "PARTNERS PHYSICIAN GROUP MEDICARE #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1225212707 . This is a "AKRON BREAST SURGEONS TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2551671 . This is a "PARTNERS PHYSICIAN GROUP MEDICAID #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3810026956 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841239274 . This is a "PARTNERS PHYSICIAN GROUP NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".