Provider Demographics
NPI:1821079625
Name:LADD, JILL JAYSON (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:JAYSON
Last Name:LADD
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 1:11850 W MARKET PL
Mailing Address - Street 2:SUITE P
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2670
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:240-485-5407
Practice Address - Street 1:2301 RESEARCH BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3204
Practice Address - Country:US
Practice Address - Phone:301-424-3444
Practice Address - Fax:301-926-0655
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022868207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD526691200Medicaid
MD526691200Medicaid
MD000F44C21Medicare PIN