Provider Demographics
NPI:1174605760
Name:HILL, JEROME C (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:C
Last Name:HILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WANDER COURT
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077
Mailing Address - Country:US
Mailing Address - Phone:518-439-6244
Mailing Address - Fax:
Practice Address - Street 1:149 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3201
Practice Address - Country:US
Practice Address - Phone:518-434-8121
Practice Address - Fax:518-426-0620
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1802101207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07210OtherMVP INS
NY10000891OtherCDPHP INS
NY070008567OtherRAILROAD MEDICARE
NY070008567OtherRAILROAD MEDICARE
NY10000891OtherCDPHP INS