Provider Demographics
NPI:1538382437
Name:GUARNASCHELLI, JESSICA N (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:N
Last Name:GUARNASCHELLI
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 1:4685 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3397
Mailing Address - Country:US
Mailing Address - Phone:513-853-4721
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:10550 MONTGOMERY RD
Practice Address - Street 2:SUITE 22
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4498
Practice Address - Country:US
Practice Address - Phone:513-984-6973
Practice Address - Fax:513-984-6976
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0921912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100062810Medicaid
OH2925240Medicaid
OH000000585569OtherANTHEM
IN200932130Medicaid
IN200932130Medicaid