Provider Demographics
NPI:1821070848
Name:DILLON, JOHANNE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNE
Middle Name:ELIZABETH
Last Name:DILLON
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:UK HEALTHCARE
Mailing Address - Street 2:800 ROSE STREET, HX314A
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-2105
Mailing Address - Fax:859-257-4457
Practice Address - Street 1:UK HEALTHCARE
Practice Address - Street 2:800 ROSE STREET, HX314A
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-2105
Practice Address - Fax:859-257-4457
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY448112085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468286OtherTUFTS HEALTH PLAN
MA2101980Medicaid
MAJ28601OtherBCBS MA
I32575Medicare UPIN
MAJ28601OtherBCBS MA