Provider Demographics
NPI:1497035604
Name:HILL, JENNIFER LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:HILL
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 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:4901 N 44TH ST STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2782
Practice Address - Country:US
Practice Address - Phone:602-954-0405
Practice Address - Fax:602-954-0485
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49506207K00000X, 207K00000X
COTL0005450207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ948075Medicaid
AZZ287284OtherMEDICARE PTAN