Provider Demographics
NPI:1528042629
Name:WEBER, JILL MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:WEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:236 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-5655
Mailing Address - Country:US
Mailing Address - Phone:610-983-9100
Mailing Address - Fax:
Practice Address - Street 1:236 HUDSON DR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-5655
Practice Address - Country:US
Practice Address - Phone:610-983-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268282207Q00000X
RIDO00722207Q00000X
NJ25MB09254300207Q00000X
IL036.132263207Q00000X
CT051611207Q00000X
DEC2-0008542207Q00000X
MDH0063585207Q00000X
WV2815207Q00000X
VA0102203675207Q00000X
VT032.0091528207Q00000X
SC36657207Q00000X
OH34.011192207Q00000X
NC2013-02455207Q00000X
NH16334207Q00000X
PAOS012849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I17835Medicare UPIN