Provider Demographics
NPI:1508128398
Name:WAWRZYNIAK, JILLIAN (MD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:WAWRZYNIAK
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 1:826 MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4478
Mailing Address - Country:US
Mailing Address - Phone:610-933-8484
Mailing Address - Fax:610-917-0320
Practice Address - Street 1:826 MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4478
Practice Address - Country:US
Practice Address - Phone:610-933-8484
Practice Address - Fax:610-917-0320
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD456146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine