Provider Demographics
NPI:1104862440
Name:OWENS, JILL M (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:OWENS
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 1:14 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3335
Mailing Address - Country:US
Mailing Address - Phone:814-362-6962
Mailing Address - Fax:814-362-4956
Practice Address - Street 1:14 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3335
Practice Address - Country:US
Practice Address - Phone:814-362-6962
Practice Address - Fax:814-362-4956
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-068703-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001797208Medicaid
PA001797208Medicaid
PA075324Medicare PIN