Provider Demographics
NPI:1912964248
Name:FOX, JILLIAN E (PA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:E
Last Name:FOX
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:E
Other - Last Name:MUHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:34TH STREET AND CIVIC CENTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-590-1000
Mailing Address - Fax:
Practice Address - Street 1:34TH STREET AND CIVIC CENTER BOULEVARD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057539363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11563506OtherCAQH
NY000570413003OtherBCBS OF WNY
NY177880BFOtherPREFERRED CARE
NY9511753OtherIHA
NYP00236020OtherMEDICARE RAILROAD
NY177880BFOtherPREFERRED CARE
NY9511753OtherIHA