Provider Demographics
NPI:1184699886
Name:SAMALE, JILL MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:SAMALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:780 MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-2148
Mailing Address - Country:US
Mailing Address - Phone:413-528-1470
Mailing Address - Fax:413-528-3167
Practice Address - Street 1:777 NORTH ST STE 301
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4172
Practice Address - Country:US
Practice Address - Phone:413-499-8570
Practice Address - Fax:413-499-8565
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA221324207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09463Medicare ID - Type Unspecified
VT00068847OtherBLUE CROS BLUE SHIELD VT
NEAA46128OtherHPHC
RII09463Medicare UPIN
NH30205553Medicaid
NH793012OtherMVP
VT1012023Medicaid
RI007059464Medicaid