Provider Demographics
NPI:1336325596
Name:MOORCROFT, JILL E (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:MOORCROFT
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Gender:F
Credentials:DO
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Mailing Address - Street 1:279 NEW BRITAIN RD, #6
Mailing Address - Street 2:ORIGINS OF HEALTH, LLC
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037
Mailing Address - Country:US
Mailing Address - Phone:860-438-7096
Mailing Address - Fax:860-438-7134
Practice Address - Street 1:279 NEW BRITAIN RD, #6
Practice Address - Street 2:ORIGINS OF HEALTH, LLC
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037
Practice Address - Country:US
Practice Address - Phone:860-438-7096
Practice Address - Fax:860-438-7134
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2012-07-31
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Provider Licenses
StateLicense IDTaxonomies
CT390200000X
CT047425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program