Provider Demographics
NPI:1184945586
Name:FORTIER, JILLIAN LEA (MD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEA
Last Name:FORTIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:LEA
Other - Last Name:DUMEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-8080
Mailing Address - Fax:860-679-1430
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:RESIDENCY ADMINISTRATION- AG093
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-1921
Practice Address - Country:US
Practice Address - Phone:860-679-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0607972086S0122X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program