Provider Demographics
NPI:1265627053
Name:TIERNEY, JILL ANN (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:TIERNEY
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 1:165 LOG CANOE CIR STE E
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2150
Mailing Address - Country:US
Mailing Address - Phone:410-643-1000
Mailing Address - Fax:
Practice Address - Street 1:165 LOG CANOE CIR STE E
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2150
Practice Address - Country:US
Practice Address - Phone:410-643-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066192208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics