Provider Demographics
NPI:1639347115
Name:MAROUSEK, JILLIAN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:LEE
Last Name:MAROUSEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:LEE
Other - Last Name:ANSPACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:TPM 3
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:434-825-8068
Mailing Address - Fax:
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:TPM 3
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:434-825-8068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045071207L00000X
NY235319207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology