Provider Demographics
NPI:1801846944
Name:HEBERT, JILLYN BETH (MPH, PA-C (MSHS))
Entity Type:Individual
Prefix:MRS
First Name:JILLYN
Middle Name:BETH
Last Name:HEBERT
Suffix:
Gender:F
Credentials:MPH, PA-C (MSHS)
Other - Prefix:MS
Other - First Name:JILLYN
Other - Middle Name:BETH
Other - Last Name:ZENTGRAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, PA-C (MSHS)
Mailing Address - Street 1:1500 FOREST GLEN ROAD
Mailing Address - Street 2:HOLY CROSS HOSPITAL INTERVENTIONAL RADIOLOGY
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-754-7350
Mailing Address - Fax:301-754-7376
Practice Address - Street 1:1500 FOREST GLEN ROAD
Practice Address - Street 2:HOLY CROSS HOSPITAL INTERVENTIONAL RADIOLOGY
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:301-754-7350
Practice Address - Fax:301-754-7376
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002364363A00000X
MDC02364363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKR80C324Medicare ID - Type Unspecified
MDP44307Medicare UPIN