Provider Demographics
NPI:1861660201
Name:IMAGIRE, JILLIAN S (MD)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:S
Last Name:IMAGIRE
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 1:3 BURNHAM RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1905
Mailing Address - Country:US
Mailing Address - Phone:781-860-0045
Mailing Address - Fax:
Practice Address - Street 1:CONCERT PHARMACEUTICALS
Practice Address - Street 2:99 HAYDEN AVE, SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421
Practice Address - Country:US
Practice Address - Phone:781-860-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1522992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology