Provider Demographics
NPI:1881627537
Name:DILLOW, JOLINDA R (MD)
Entity type:Individual
Prefix:DR
First Name:JOLINDA
Middle Name:R
Last Name:DILLOW
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:PO BOX 2059
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2059
Mailing Address - Country:US
Mailing Address - Phone:606-324-0051
Mailing Address - Fax:606-325-2244
Practice Address - Street 1:336 29TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1900
Practice Address - Country:US
Practice Address - Phone:606-324-0051
Practice Address - Fax:606-325-2244
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32439207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65930992Medicaid
000000052094OtherANTHEM
5970147OtherAETNA
G29960Medicare UPIN
KY65930992Medicaid