Provider Demographics
NPI:1508352048
Name:WALSH, JILLIAN PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:PATRICIA
Last Name:WALSH
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:BRIGHAM & WOMEN'S HOSPITAL, VASCULAR AND ENDOVASCULAR S
Mailing Address - Street 2:75 FRANCIS ST.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:857-307-1920
Mailing Address - Fax:857-307-1922
Practice Address - Street 1:2 CAPITAL WAY STE 356
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-537-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2021-04-22
Deactivation Date:2019-02-13
Deactivation Code:
Reactivation Date:2019-03-20
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA109233002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program