Provider Demographics
NPI:1235332263
Name:KISSOLOVEGE, JILL (DO)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:KISSOLOVEGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 MOOSIC ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2105
Mailing Address - Country:US
Mailing Address - Phone:570-800-5926
Mailing Address - Fax:
Practice Address - Street 1:1141 MOOSIC ST
Practice Address - Street 2:STE 3
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2105
Practice Address - Country:US
Practice Address - Phone:570-800-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-010470-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine