Provider Demographics
NPI:1609830736
Name:ALLBRITTON, JILL (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ALLBRITTON
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 1:7814 BLUE RIBBON ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2463
Mailing Address - Country:US
Mailing Address - Phone:410-206-6886
Mailing Address - Fax:
Practice Address - Street 1:810 LANDMARK DRIVE
Practice Address - Street 2:SUITE 217-219
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061
Practice Address - Country:US
Practice Address - Phone:888-276-2223
Practice Address - Fax:972-767-0225
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD520595110207N00000X
MDD47273207ND0900X
MAD47273207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD736420200Medicaid
MDG18205Medicare UPIN
MDKR36Medicare PIN
MDH766411UMedicare ID - Type Unspecified