Provider Demographics
NPI:1588652721
Name:ALLEN, JILL B (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:B
Last Name:ALLEN
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 267
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0267
Mailing Address - Country:US
Mailing Address - Phone:434-447-2300
Mailing Address - Fax:434-447-2377
Practice Address - Street 1:500 N THOMAS ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1421
Practice Address - Country:US
Practice Address - Phone:434-447-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010167949Medicaid
VA010167949Medicare ID - Type Unspecified
VAG63458Medicare UPIN