Provider Demographics
NPI:1184628158
Name:MELENDEZ YOUNG, JILL A (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:A
Last Name:MELENDEZ YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1493 CAMBRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-665-1552
Mailing Address - Fax:
Practice Address - Street 1:38 TYLER ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2943
Practice Address - Country:US
Practice Address - Phone:603-882-2921
Practice Address - Fax:603-882-0132
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14051207R00000X, 207RN0300X
MA220469207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2065631Medicaid
NH30207999Medicaid
MA2065631Medicaid