Provider Demographics
NPI:1619103223
Name:DORSAM, JILLIAN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:MARIE
Last Name:DORSAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 808 BOX 19
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09618-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U.S. NAVAL HOSPITAL
Practice Address - Street 2:VIA CONTRADA BOSCARIELLO
Practice Address - City:GRICIGNANO DI AVERSA
Practice Address - State:CE
Practice Address - Zip Code:81030
Practice Address - Country:IT
Practice Address - Phone:081-811-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202656207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine