Provider Demographics
NPI:1144304841
Name:PAYNE, JENNIFER E (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:PAYNE
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 1:137 LETHBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1361
Mailing Address - Country:US
Mailing Address - Phone:330-971-7892
Mailing Address - Fax:330-926-5870
Practice Address - Street 1:1900 23RD ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-971-7892
Practice Address - Fax:330-926-5870
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082787207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2413089Medicaid
OH7897565OtherAETNA
OH000000292307OtherANTHEM
OH341587155JPOtherSUMMACARE
OH7897565OtherAETNA
OH341587155JPOtherSUMMACARE
PA4111113Medicare PIN
H88273Medicare UPIN