Individual
JILL C HERTZENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 N JAMES RD, COLUMBUS, OH 43219-1834
(614) 257-5200
Mailing address
420 N JAMES RD, COLUMBUS, OH 43219-1834
(614) 257-5200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35.056454
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000317006
IND BC/BS # FOR GRADY
OH
05
—
0699838
—
OH
01
—
P00088048
IND RRMEDICARE # AT GRDY
OH
Enumeration date
04/11/2006
Last updated
08/30/2019
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