Provider Demographics
NPI:1790075901
Name:RAYBOULD, JILLIAN EILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:EILEEN
Last Name:RAYBOULD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 E MARSHALL ST
Mailing Address - Street 2:VMI BUILDING, SUITE 2015
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-1901
Mailing Address - Country:US
Mailing Address - Phone:804-828-9711
Mailing Address - Fax:804-828-3097
Practice Address - Street 1:1000 E MARSHALL ST
Practice Address - Street 2:VMI BUILDING, SUITE 2015
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-1901
Practice Address - Country:US
Practice Address - Phone:804-828-9711
Practice Address - Fax:804-828-3097
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101254733207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program