Provider Demographics
NPI:1063904704
Name:ROBILLARD, JESSE THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:THOMAS
Last Name:ROBILLARD
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 1:137 W HOUSATONIC ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6018
Mailing Address - Country:US
Mailing Address - Phone:413-441-5615
Mailing Address - Fax:
Practice Address - Street 1:205 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1918
Practice Address - Country:US
Practice Address - Phone:315-866-7630
Practice Address - Fax:315-866-0193
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
NY3208142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program