Provider Demographics
NPI:1336128982
Name:JOSEPHSON, JILL P (MD)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:P
Last Name:JOSEPHSON
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-1150
Mailing Address - Fax:704-316-1151
Practice Address - Street 1:407 N HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-6003
Practice Address - Country:US
Practice Address - Phone:704-316-1150
Practice Address - Fax:704-316-1151
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801326174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891178KMedicaid
NC2266183Medicare ID - Type UnspecifiedMEDICARE #
NC2266183BMedicare PIN
NC2266183AMedicare PIN
NCG39084Medicare UPIN
NC891178KMedicaid