Provider Demographics
NPI:1407839640
Name:BRAZELTON, JILL GALINUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:GALINUS
Last Name:BRAZELTON
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 1:690 WEST LINCOLN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-873-5437
Mailing Address - Fax:484-879-6395
Practice Address - Street 1:690 WEST LINCOLN HIGHWAY
Practice Address - Street 2:CHESTER COUNTY PEDIATRICS
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-873-5437
Practice Address - Fax:484-879-6395
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101461328Medicaid