Provider Demographics
NPI:1023094604
Name:HERR, JILL M (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:HERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:PA
Mailing Address - Zip Code:17547-1628
Mailing Address - Country:US
Mailing Address - Phone:717-426-1131
Mailing Address - Fax:717-426-2068
Practice Address - Street 1:1159 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:PA
Practice Address - Zip Code:17547-1628
Practice Address - Country:US
Practice Address - Phone:717-426-1131
Practice Address - Fax:717-426-2068
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD073963L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7169227OtherAETNA NON-HMO
PAH43987OtherHEALTH ASSURANCE
PA50043167OtherCAPITAL BLUE CROSS
PA0018550700001Medicaid
PA69346 S1QKOtherGEISINGER HEALTH PLAN
PAP002507OtherGATEWAY HEALTH PLAN
PA1310722OtherHIGHMARK BLUE SHIELD
PA2600420OtherAETNA HMO
PA2600420OtherAETNA HMO
PAH43987Medicare UPIN