Provider Demographics
NPI:1124463336
Name:SIMON, JILL KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:KATHERINE
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:KATHERINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1781 TATE BLVD SE STE 201
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4252
Mailing Address - Country:US
Mailing Address - Phone:215-534-3038
Mailing Address - Fax:
Practice Address - Street 1:1781 TATE BLVD SE STE 201
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4252
Practice Address - Country:US
Practice Address - Phone:254-724-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01639207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology