Provider Demographics
NPI:1578505863
Name:MACKEY, JILL ELISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ELISE
Last Name:MACKEY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4512 KIRKWOOD HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5125
Mailing Address - Country:US
Mailing Address - Phone:302-378-4779
Mailing Address - Fax:302-378-4789
Practice Address - Street 1:114 SANDHILL DR
Practice Address - Street 2:STE 101
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5805
Practice Address - Country:US
Practice Address - Phone:302-378-4779
Practice Address - Fax:302-378-4789
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-04-04
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Provider Licenses
StateLicense IDTaxonomies
DEC10004721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000711401Medicaid
DE000711401Medicaid
DEG30401Medicare UPIN