Provider Demographics
NPI:1790827525
Name:WORTH, JILLIAN E (MD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:WORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:E
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1344 WINTERGREEN LN NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5118
Mailing Address - Country:US
Mailing Address - Phone:206-842-5632
Mailing Address - Fax:206-842-5992
Practice Address - Street 1:1344 WINTERGREEN LN NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-842-5632
Practice Address - Fax:206-842-5992
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS2578147OtherAETNA SPECIALIST PIN
WA8289944Medicaid
WA5539WOOtherBLUE SHIELD #
WAUS2578144OtherAETNA PCP PIN
AKMD1566WMedicaid
WA0039581OtherLABOR AND INDUSTRIES #
WA0039581OtherLABOR AND INDUSTRIES #
WAUS2578147OtherAETNA SPECIALIST PIN
H49179Medicare UPIN